Aktuelle Aspekte zur supportiven und adjuvanten Therapie der Sepsis

Zusammenfassung

Sepsis ist definiert als eine systemische Entzündungsreaktion auf dem Boden eines infektiösen Fokus. Diese systemische Entzündungsreaktion ist mit der Ausschüttung multipler Zytokine vergesellschaftet. Eine Reihe von antiinflammatorisch wirksamen Substanzen wurde daher in den letzten Jahren in ihrer Wirkung auf die Mortalität von Patienten mit Sepsis untersucht. Lediglich niedrig dosiertes Hydrokortison und rekombinantes humanes aktiviertes Protein C konnten in kontrollierten Studien mit hoher Fallzahl eine Prognoseverbesserung gegenüber der Kontrollgruppe erzielen. Auch das TNF-α-Antikörperfragment Afelimomab zeigte eine Letalitätssenkung, steht aber nicht als Medikament zur Verfügung. Für Ibuprofen, Interleukin-1-Rezeptor-Antagonisten und lösliche TNF-α-Rezeptoren sowie eine hoch dosierte Kortikosteroid- oder Antithrombin-III-Behandlung als antiinflammatorische bzw. antikoagulatorische Therapie in der Sepsis gibt es momentan keine wissenschaftlich eindeutig gesicherte Indikation. Vor der adjuvanten antiinflammatorischen Therapie steht in jedem Falle die Kontrolle des Infektionsfokus sowie eine aggressive Kreislaufstabilisierung.

Abstract

Sepsis is defined as a systemic inflammatory response to an infection. This systemic inflammatory response is associated with release of multiple cytokines. During the last years, several antiinflammatory and anticoagulatory substances had been investigated regarding their effects on mortality in patients with sepsis. However, only low-dose hydrocortisone and the recombinant human activated protein C were capable in improving the outcome in controlled studies with large sample size. The antibody fragment of the TNF-α binding antibody afelimomab also reduced sepsis mortality but is not available as a licensed drug. Ibuprofen, interleukin-1 receptor antagonists and soluble TNF-α-receptors as well as high dosages of corticosteroids do not have a place in the adjunctive treatment of sepsis. Clear data about the usefulness of antithrombin III are missing. Beside the antiinflammatory treatment, the control of the infectious focus and an aggressive hemodynamic stabilization must not be neglected.

Schlüsselwörter

Sepsis - Prognose - Kreislaufstabilisierung - adjuvante Therapien - aktiviertes Protein C

Key words

Sepsis - outcome - circulatory support - adjuvant therapies - activated protein C

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