Persistent Inflammation, Immunosuppression and Catabolism Syndrome.
Persistent Inflammation, Immunosuppression and Catabolism Syndrome.
复制标题
DOI：
10.1016/j.ccc.2016.12.001
复制
发表时间：
2017-04
影响因子：
4.3
通讯作者：
Moore FA
中科院分区：
文献类型：
--
作者：
Mira JC;Brakenridge SC;Moldawer LL;Moore FA
在过去的四十年中，由于护理的进步，多器官衰竭（MOF）的流行病学发生了变化。已经描述了一系列范例来解释新出现的主要表型的病理生理学。随着重症监护服务的最新改进，患者在临床病程早期死亡的频率降低，院内MOF相关死亡率也在下降。不幸的是，这导致了在重症监护室（ICU）逗留的慢性危重病患者（CCI）的数量急剧增加，具有高资源利用率，被出院到非家庭位置，经历败血症复发需要再次入院，具有持续的认知和功能障碍，以及长期生存率差。在这一人群中，我们提出这些患者中有相当一部分患有一种称为持续性炎症、免疫抑制和卡他综合征（PICS）的新表型，这是这些不良结局的基础。虽然PICS的机制正在研究中，但有证据表明，骨髓增生异常伴髓源性抑制细胞扩增、先天性和适应性免疫抑制以及蛋白质代谢紊乱伴营养不良是主要原因。这些患者的最佳护理需要使用药物治疗、物理治疗和营养支持的新型多模式干预。
Over the past four decades the epidemiology of multiple organ failure (MOF) has evolved as a result of advances in care. A series of paradigms have been described to explain the pathophysiology of the new emerging predominant phenotypes. With the most recent improvements in the delivery of critical care, patients are less-frequently expiring early in their clinical course and in-hospital MOF-related mortality is on the decline. Unfortunately, this has resulted in a dramatic increase in the number of chronic critically ill patients (CCI) who linger in the intensive care unit (ICU), have high resource utilization, are discharged to non-home locations, experience sepsis recidivism requiring readmission, have persistent cognitive and functional impairments, and poor long-term survival. Within this population, we have proposed that a substantial subset of these patients suffer from a new phenotype termed Persistent Inflammation, Immunosuppression, and Catabolism Syndrome (PICS) which underlies these poor outcomes. While the mechanism(s) of PICS are under investigation, there is evidence that myelodysplasia with expansion of myeloid derived suppressor cells, innate and adaptive immune suppression and protein catabolism with malnutrition are major contributors. Optimal care of these patients will require a novel multimodality intervention using pharmacotherapy, physiotherapy and nutritional support.