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Glucocorticoids in Sepsis: To Be or Not to Be

Authors: Jolien Vandewalle; Jolien Vandewalle; Claude Libert; Claude Libert;

Glucocorticoids in Sepsis: To Be or Not to Be

Abstract

Sepsis is a highly lethal syndrome resulting from dysregulated immune and metabolic responses to infection, thereby compromising host homeostasis. Activation of the hypothalamic-pituitary-adrenal (HPA) axis and subsequently adrenocortical glucocorticoid (GC) production during sepsis are important regulatory processes to maintain homeostasis. Multiple preclinical studies have proven the pivotal role of endogenous GCs in tolerance against sepsis by counteracting several of the sepsis characteristics, such as excessive inflammation, vascular defects, and hypoglycemia. Sepsis is however often complicated by dysfunction of the HPA axis, resulting from critical-illness-related corticosteroid insufficiency (CIRCI) and GC resistance. Therefore, GCs have been tested as an adjunctive therapy in sepsis and septic shock in different randomized clinical trials (RCTs). Nonetheless, these studies produced conflicting results. Interestingly, adding vitamin C and thiamin to GC therapy enhances the effects of GCs, probably by reducing GC resistance, and this results in an impressive reduction in sepsis mortality as was shown in two recent preliminary retrospective before-after studies. Multiple RCTs are currently underway to validate this new combination therapy in sepsis.

Related Organizations
Keywords

Hypothalamo-Hypophyseal System, HPA axis dysfunction, Immunology, FUNCTION, Pituitary-Adrenal System, HAT therapy, PHOSPHOENOLPYRUVATE CARBOXYKINASE, sepsis, Receptors, Glucocorticoid, Sepsis, glucocorticoid resistance, Medicine and Health Sciences, Animals, Humans, CORTICOSTEROID INSUFFICIENCY, Glucocorticoids, TUMOR-NECROSIS-FACTOR, ENDOGENOUS GLUCOCORTICOIDS, NITRIC-OXIDE, VITAMIN-C, RECEPTOR, glucocorticoids, LOW-DOSE HYDROCORTISONE, SEPTIC SHOCK, Biology and Life Sciences, RC581-607, ASCORBIC-ACID, Immunologic diseases. Allergy

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    Top 1%
    influence
    This indicator reflects the overall/total impact of an article in the research community at large, based on the underlying citation network (diachronically).
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    impulse
    This indicator reflects the initial momentum of an article directly after its publication, based on the underlying citation network.
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selected citations
These citations are derived from selected sources.
This is an alternative to the "Influence" indicator, which also reflects the overall/total impact of an article in the research community at large, based on the underlying citation network (diachronically).
BIP!Citations provided by BIP!
popularity
This indicator reflects the "current" impact/attention (the "hype") of an article in the research community at large, based on the underlying citation network.
BIP!Popularity provided by BIP!
influence
This indicator reflects the overall/total impact of an article in the research community at large, based on the underlying citation network (diachronically).
BIP!Influence provided by BIP!
impulse
This indicator reflects the initial momentum of an article directly after its publication, based on the underlying citation network.
BIP!Impulse provided by BIP!
96
Top 1%
Top 10%
Top 1%
Green
gold