[Post-aggression metabolism: attempt at a status determination].

OBJECTIVE

Selection of important results in pathophysiology and pathobiochemistry of the surgical patient.

SOURCES

Anglo-American and German literature since 1988.

SELECTION CRITERIA

Importance of reported results for the understanding of superior interactions.

RESULTS

The term 'postaggression' syndrome was introduced on the basis of earlier observations regarding the pathophysiology of the surgical patient. More recent results which addressed pathobiochemistry, and which had been obtained by methods of molecular biology, led to the new definition as systemic inflammatory response syndrome (SIRS). Knowledge on metabolic changes which are associated with SIRS increased significantly in the field of protein and carbohydrate metabolism. Concerning the clinically important phenomenon of protein catabolism, it is possible today to differentiate between changes in protein synthesis and protein degradation. The time period which had passed since the underlying trauma and the variable responses of different organ systems were recognized as important variables of catabolism. The ongoing question regarding possible mediators of protein catabolism still remains unanswered. Release of cytokines which can be observed in SIRS appears to play only an indirect role. The small bowel, which is important for the general pathophysiology of SIRS, gained a central position in amino acid metabolism (especially glutamine metabolism). A new aspect of carbohydrate metabolism was found in the liver. The accelerated cycling of glucose molecules between glucose, glucose-6-phosphate, and glucose (glucose cycling) seems to contribute to the increased energy expenditure found in SIRS.

CONCLUSIONS

Use of new methods in in vivo and in vitro research significantly expanded the knowledge on pathophysiological and pathobiochemical mechanisms in SIRS. Future research activities should tie together these individual mechanisms into the complex network as it presents to the physician during clinical routine.