Immune Distress аs Pathogenetic аnd Thanatogenetic Relevant Syndrome in Severe Sepsis and Septic Shock: Clinical and Pathomorphological Substantiation of Early Replacement Immunocorrection

A.N. Nesterenko

Abstract


The authors carried out retrospective cohort study of 67 patients who died due to severe sepsis and septic shock, as part of a non-randomized observational cohort controlled clinical study of 208 patients of Donetsk regional clinical territorial medical association (January 1995 — April 2010 ) with severe sepsis (167 persons) and septic shock (41 persons). Clinical and pathomorphological analysis of sepsis thanatogenesis enabled to confirm the existence of three phases of its course, to consider immune distress as one of the key links of pathogenesis, the development of organ dysfunction and sepsis thanatogenesis, to justify the appropriateness of the early replacement immunocorrection with intravenous immunoglobulin preparations as a component of the algorithm for emergency goal-directed organoprotective therapy of sepsis. Treatment according to designed algorithm made it possible statistically significant decrease, in comparison with the controls, of risks and the chances of fatal outcome in 82 patients of the study group with severe surgical sepsis (p = 0.038): relative risk (RR) = 1.76 (95% confidence interval (CI) 1.06–2.92); absolute risk reduction (ARR) = 15.74 % (95% CI 2.0–28.7 %); number needed to treat (NNT) = 6.4 (95% CI 3.5–50.1); odds ratio (OR) = 0.46 (95% CI 0.23–0.91), χ2 = 5.28 > χ2crit. = 3.84 (control — 85 patients), and in 21 patients from the study group with septic shock (p = 0.046): RR = 2.28 (95% CI 1.08–4.81), ARR = 36.43 % (95% CI 6.0–58.9 %); NNT = 2.7 (95% CI 1.7–16.8); OR = 0.23 (95% CI 0.06–0.81), p = 0.043;
χ2 = 4.10 > χ2crit. = 3.84 (control — 20 patients).


Keywords


severe sepsis; septic shock; clinical and pathomorphological analysis of thanatogenesis of sepsis; stages of sepsis; immune distress; early replacement immunocorrection; intravenous immunoglobulins

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DOI: https://doi.org/10.22141/2224-0586.6.53.2013.88704

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