La sepsi: facciamo il punto

The Sepsis Syndrome, as defined by the Consensus Conference, is a pathological condition with a high mortality and morbidity. In physiological condition an immunological cascade assures a prompt reaction to bacteria. A too much strong reaction can damage the host. The complexity of the immunological reaction makes difficult every specific therapy. Hypotension associated to septic shock is due to systemic vasodilation, myocardial depression and lead to multiorgan failure and death. Many sperimental and human studies indicate that this hypotension is due to the production of a large amount of nitric oxide (NO). The host reaction is so important as the site of the infection or the type of microorganism involved. Inflammation and coagulation are strictly linked. Many inflammatory mediators released during inflammation are also pro-coagulation and lead to sepsis. Moreover also the bacteria can cause an endothelial damage which a pro-coagulant action. During the last 15 years more then 20 multicenter trials have been performed to experiment new therapies. All these new therapies failed to reduce mortality. Only recently a new substance, C activated protein, with fibrinolitic, anti-inflammatory and anticoagulant properties, was able in PROWESS study to reduce significantly mortality of 6,1% with a reduction of the relative risk of 19,4%.