Sepsis

Sepsis

  

• J
  Schroder, V Kahlke, K-H Staubach et al 1998. (Univ of Kiel, Germany; Univ of
  Lubeck, Germany; Ctr of Research, Borstel, Germany et al): Gender Differences in Human Species. Arch Surg 133: 1200 -1205. 
  
     
  
  Sepsis appears to have a better prognosis in women than in men. The survival advantage of women may be related to their higher levels of anti-inflammatory mediators such as IL-10
  (interleukin). (The relative proportions of pro-inflammatory and anti-inflammatory mediators may be an important therapeutic target).
  
      
  
  Are testosterone antagonists beneficial ?
  
    
  

• MM,
  for the Ibuprofen in Sepsis Study group [Vanderbilt
  Univ., Nashville, Tenn] Arons
  
  Effects of Ibuprofen on the Physiology and
  Survival of Hypothermic 
  Sepsis
  
  Crit Care Med 
  27:699-707, 1999
  
     
  
  Patients
  whose response to sepsis is hypothermic rather than
  febrile have a poor prognosis. It has been suggested
  that patients with hypothermic 
  sepsis represent a clinically and
  biochemically distinct subgroup. This hypothesis was
  studied, along with the response to ibuprofen
  treatment in patients with hypothermic sepsis.
  
    
  
  The multicenter trial included 455 patients
  admitted to the ICU with severe sepsis and a known
  or suspected serious infection. 
  Patients with hypothermic sepsis were
  identified, and their clinical and physiologic
  findings were compared with those of patients with
  febrile sepsis. 
  Plasma cytokines measured included tumor
  necrosis factor [TNF –alpha] and interleukin
  [IL]-6, along with the lipid mediators thromboxane
  B2[TxB], and prostacyclin. Hypothermic patients were
  randomized to receive ibuprofen [10 mg/kg IV over 30
  to 60 minutes every 6 hours for 8 doses, to a
  maximum of 800 gm] or to receive a placebo.
  
    
  
  Ten percent
  of all patients with sepsis were hypothermic, with a
  temperature below 35.5 degrees celsius. 
  The mortality rate was double in these
  patients compared to the rest [70% vs 35%], and they
  had significant baseline elevations of urinary TxB,
  metabolites, prostacyclin, and serum TNF-alpha and
  IL-6, compared with the febrile group.
  
    
  
  Twenty-four patients with hypothermic sepsis were
  assigned to ibuprofen and twenty two placebo. The
  30-day morality was 54% in those receiving ibuprofen
  vs 90% in those on placebo. 
  Ibuprofen treatment was also associated with
  a trend toward increased number of days free from
  major organ system failures.
  
     
  
  About ten percent of the patients with sepsis
  have hypothermia instead of a febrile response. Such
  patients have an increased mortality. 
  Treatment with ibuprofen may reduce
  mortality, but prospective confirmation of these
  findings is needed.