The metabolic response to sepsis: relevance to treatment

Sepsis is defined as the systemic inflammatory response syndrome (SIRS) associated with suspected or confirmed infection. Despite ongoing improvements in healthcare and its provision, sepsis remains a leading cause of death amongst hospitalized patients and presents an ongoing daily challenge for jobbing clinicians.In recent years, the management of patients with sepsis has been aided by a much better understanding of the underlying pathophysiological processes which occur. In particular, we have a better perception of the complex interactions between the host and the invading organisms as well as a better appreciation of the cellular and extracellular pathways involved, including, but not confined to the complexly intertwined roles of the immunological system, the complement cascade and the coagulation pathway, as well as the role of the gut in driving this process. Similarly there has been an explosion in research pertaining to biomarkers of sepsis which can be used either as diagnostic markers or as prognostic indicators.When considering sepsis and planning its treatment, the importance of considering in detail those aspects which predispose to sepsis, factors relevant to the infection itself, the response of the host to the infection as well as any resultant organ dysfunction is widely recognized. This better understanding has permitted improvements in how septic patients are treated, including the advent of ‘care bundles’ such as those promoted by the ‘Surviving Sepsis Campaign’. This better appreciation has also spawned new research and opened up new lines of enquiry as to how improvements in the care of septic patients may be pursued in the future.