Innate Immunity in the Persistent Inflammation, Immunosuppression, and Catabolism Syndrome and Its Implications for Therapy.
Innate Immunity in the Persistent Inflammation, Immunosuppression, and Catabolism Syndrome and Its Implications for Therapy.
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DOI：
10.3389/fimmu.2018.00595
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发表时间：
2018
影响因子：
7.3
通讯作者：
Sepsis and Critical Illness Research Center Investigators
中科院分区：
文献类型：
--
作者：
Horiguchi H;Loftus TJ;Hawkins RB;Raymond SL;Stortz JA;Hollen MK;Weiss BP;Miller ES;Bihorac A;Larson SD;Mohr AM;Brakenridge SC;Tsujimoto H;Ueno H;Moore FA;Moldawer LL;Efron PA;Sepsis and Critical Illness Research Center Investigators
临床和技术进步促进了早期出血控制和生理复苏以及脓毒症的早期诊断和最佳治疗，显著降低了许多危重患者人群的住院死亡率。然而，相当一部分严重创伤和脓毒症幸存者将发展为长期器官功能障碍，称为慢性危重病（CCI），定义为≥14天需要重症监护室（ICU）资源，持续器官功能障碍。CCI患者的一个子集将发展为持续性炎症、免疫抑制和卡他综合征（PICS），并且这些个体倾向于生活质量差和惰性死亡。我们认为创伤或脓毒症后CCI和PICS是不适当的骨髓反应的结果，其特征是以淋巴细胞和红细胞生成为代价产生功能障碍的骨髓细胞群。本文综述了CCI/PICS表型在败血症、癌症和衰老中的相似性，并回顾了异常骨髓生成在CCI和PICS病理生理学中的作用。此外，我们还描述了病原体识别，先天和适应性免疫系统之间的界面，以及包括免疫调节剂，肠道微生物群支持以及营养和运动疗法在内的治疗方法。最后，我们讨论了在大数据上训练和验证的机器和深度学习模型指导下的诊断和预后方法的未来，以确定这些方法将产生最大益处的患者。对CCI和PICS的病理生理学的更深入了解以及对新疗法的持续研究，有可能改善危重创伤后和感染后患者目前令人沮丧的长期结局。
Clinical and technological advances promoting early hemorrhage control and physiologic resuscitation as well as early diagnosis and optimal treatment of sepsis have significantly decreased in-hospital mortality for many critically ill patient populations. However, a substantial proportion of severe trauma and sepsis survivors will develop protracted organ dysfunction termed chronic critical illness (CCI), defined as ≥14 days requiring intensive care unit (ICU) resources with ongoing organ dysfunction. A subset of CCI patients will develop the persistent inflammation, immunosuppression, and catabolism syndrome (PICS), and these individuals are predisposed to a poor quality of life and indolent death. We propose that CCI and PICS after trauma or sepsis are the result of an inappropriate bone marrow response characterized by the generation of dysfunctional myeloid populations at the expense of lympho- and erythropoiesis. This review describes similarities among CCI/PICS phenotypes in sepsis, cancer, and aging and reviews the role of aberrant myelopoiesis in the pathophysiology of CCI and PICS. In addition, we characterize pathogen recognition, the interface between innate and adaptive immune systems, and therapeutic approaches including immune modulators, gut microbiota support, and nutritional and exercise therapy. Finally, we discuss the future of diagnostic and prognostic approaches guided by machine and deep-learning models trained and validated on big data to identify patients for whom these approaches will yield the greatest benefits. A deeper understanding of the pathophysiology of CCI and PICS and continued investigation into novel therapies harbor the potential to improve the current dismal long-term outcomes for critically ill post-injury and post-infection patients.
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影响因子：
120.7
作者：
Boomer, Jonathan S.;To, Kathleen;Chang, Kathy C.;Takasu, Osamu;Osborne, Dale F.;Walton, Andrew H.;Bricker, Traci L.;Jarman, Stephen D., II;Kreisel, Daniel;Krupnick, Alexander S.;Srivastava, Anil;Swanson, Paul E.;Green, Jonathan M.;Hotchkiss, Richard S.
通讯作者：
Hotchkiss, Richard S.
影响因子：
64.8
作者：
Alexopoulou, L;Holt, AC;Flavell, RA
通讯作者：
Flavell, RA
DOI：
10.1186/cc12711
发表时间：
2013-05-11
期刊：
Critical care (London, England)
影响因子：
--
作者：
Chang KC;Burnham CA;Compton SM;Rasche DP;Mazuski RJ;McDonough JS;Unsinger J;Korman AJ;Green JM;Hotchkiss RS
通讯作者：
Hotchkiss RS
影响因子：
4.8
作者：
Bruns, Annie M.;Pollpeter, Darja;Horvath, Curt M.
通讯作者：
Horvath, Curt M.
影响因子：
11.2
作者：
Bunt, Stephanie K.;Yang, Linglin;Ostrand-Rosenberg, Suzanne
通讯作者：
Ostrand-Rosenberg, Suzanne