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Liver, Biliary Tract and Pancreatic Disease
Published in John S. Axford, Chris A. O'Callaghan, Medicine for Finals and Beyond, 2023
There are several systems for assessing the severity of the attack: The Ransom system was developed for patients with alcohol-related pancreatitis.The APACHE II score is also helpful.SIRS and multi-organ failure (especially if developing after 48 hours) are markers of severity.
Intensive Care Management of Major Trauma
Published in Ian Greaves, Keith Porter, Jeff Garner, Trauma Care Manual, 2021
Ian Greaves, Keith Porter, Jeff Garner
The impact of the inflammatory response syndrome (SIRS) on the severely injured cannot be understated. There is emerging evidence which points to an exaggerated SIRS response in some patients, as well as modification of the response in relation to the resuscitation strategy employed. SIRS is not inherently dangerous and is ultimately required for tissue repair but an unregulated response in extreme conditions can compromise healthy tissue, distant end-organs and further promote inflammation. SIRS in trauma is characterized by a three-tier response: metabolic, immunological and haemodynamic.
Septic shock
Published in Hung N. Winn, Frank A. Chervenak, Roberto Romero, Clinical Maternal-Fetal Medicine Online, 2021
Bryan E. Freeman, Michael R. Foley
SIRS can be the result of a variety of injuries (trauma, infection, burns, or sterile inflammatory processes such as pancreatitis) that lead to a series of complex findings. Assigning the diagnosis by 1992 criteria initially required at least two of the following: Body temperature >38°C or <36°CHR >90 bpmTachypnea (RR >20/min) or hyperventilation (PaCO2 <32 mmHg)WBC count >12,000 cells/μL or <4000 cells/μL, or presence of bands (7)
Surgical stress quickly affects the numbers of circulating B-cells and neutrophils in murine septic and aseptic models through a β2 adrenergic receptor
Published in Journal of Immunotoxicology, 2022
Ryutaro Nishioka, Yusuke Nishi, Mohammed E. Choudhury, Riko Miyaike, Ayataka Shinnishi, Kensuke Umakoshi, Yasutsugu Takada, Norio Sato, Mayuki Aibiki, Hajime Yano, Junya Tanaka
Sepsis, a significant cause of death in intensive care units worldwide, is difficult to treat (Fleischmann et al. 2016). Sepsis pathogenesis has long been attributed to intense systemic inflammatory responses to bacteria, viruses, or endogenous damage-associated molecular patterns that stimulate pattern recognition receptors, such as Toll-like receptors, produced by immune cells (Zhang et al. 2010; Denning et al. 2019). A typical marker of sepsis is the increased production of pro-inflammatory cytokines, like tumor necrosis factor (TNF)-α, interleukin (IL)-1β, and IL-6 (Bozza et al. 2007; Kikuchi et al. 2015). Therefore, the term systemic inflammatory response syndrome (SIRS) is used almost synonymously with sepsis (Balk 2014). However, the current focus on sepsis is on anti-inflammatory responses and a chronic condition known as immune paralysis (Boomer et al. 2011; Leentjens et al. 2013). This paralysis is characterized by decreases in lymphocytes which hinders pathogen elimination as well as appropriate immune responses, leading to secondary opportunistic infections and a resultant poor prognosis.
Carbapenem-resistant Gram-negative pathogens associated with septic shock: a review of 120 cases
Published in Journal of Chemotherapy, 2022
Uğur Önal, Deniz Akyol, Merve Mert, Dilşah Başkol, Seichan Chousein Memetali, Gamze Şanlıdağ, Buse Kenanoğlu, Ayşe Uyan-Önal, Günel Quliyeva, Cansu Bulut Avşar, Damla Akdağ, Melike Demir, Hüseyin Aytaç Erdem, Ümit Kahraman, Osman Bozbıyık, Erkin Özgiray, Devrim Bozkurt, Funda Karbek Akarca, Kubilay Demirağ, İlkin Çankayalı, Mehmet Uyar, Feriha Çilli, Bilgin Arda, Tansu Yamazhan, Hüsnü Pullukçu, Meltem Işıkgöz Taşbakan, Hilal Sipahi, Sercan Ulusoy, Oguz Resat Sipahi
Another critical change in 2021 guidelines was the recommendation of not using qSOFA but using SIRS, National Early Warning Score (NEWS), or The Modified Early Warning Score (MEWS) as a single screening tool for sepsis or septic shock [24]. A systematic review and meta-analysis showed that SIRS was significantly superior to qSOFA for sepsis diagnosis (risk ratio = 1.32, 95% CI: 0.40–2.24, P < 0.001, I2 = 100%) whereas qSOFA was more specific but less sensitive than having two of four SIRS criteria for the early identification of infection-induced organ dysfunction [24, 25]. In our study, all patients had a SIRS score of 2 or more. The mortality rate among the patients having an SIRS score 3 or 4 was 88% (61/69) versus 73% (37/51) among those with an SIRS score 2 points (P = 0.026).
Development and validation of a nomogram for early assessment the severity of acute pancreatitis
Published in Scandinavian Journal of Gastroenterology, 2022
Guang-hua Liu, Jie Chen, Ling-qian Li, Xi-sha Huan, Ping Lei
AP is often accompanied by decreasing serum level of Ca2+. Ca2+ was verified to be an independent risk factor for the development of POF [17]. Studies suggested that Ca2+ was a useful severity predictor in AP [18,19]. Proposed mechanisms for hypocalcemia are as follows: autodigestion of mesenteric fat by pancreatic enzymes lead to release of free fatty acids, which form calcium salts; catecholamine-mediated translocation of plasma calcium ion into tissues caused hypocalcemia [20]. Our data illustrated that Ca2+ with an OR of 0.151 (95% CI 0.084–0.273) was independently associated with SAP. NLR is an inflammatory marker reflecting the balance between inflammatory activator neutrophils and inflammatory regulator lymphocytes [21]. An expanding body of evidence showed that NLR was associated with AP and could be an inflammation marker in predicting the severity and prognosis of AP [22–24]. Our data suggested that NLR with an OR of 1.055 (95% CI 1.23–1.088) was independently associated with SAP. SIRS is an inflammatory process that can occur in a variety of infectious and noninfectious disease. Study demonstrated that early SIRS was associated with SAP [25], it was also a simple screening tool to identify children at risk for the development of SAP on admission [26,27]. Our data identified that SIRS with an OR of 6.292 (95% CI 4.459–8.879) was independently associated with SAP.