Sepsis

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Sepsis, the complex, systemic, clinical syndrome resulting from the innate host inflammatory response to infection, is an increasingly common condition, particularly in an ageing population with multiple comorbidities. The mortality rate remains high - about 30% in the USA and Europe and much higher in the developing world. Indeed, the annual number of deaths from sepsis rivals those due to myocardial infarction and exceeds the mortality rate of virtually every common cancer, yet the syndrome has received relatively little attention as a modifiable disease process. Most therapeutic strategies target pro-inflammatory mediators, but these have frequently not improved survival of patients when studied in large, multicentre clinical trials. Greater appreciation of the complex pathophysiology by which sepsis induces multiple organ failure has stimulated research into new therapeutic approaches. Depending on the phase of the septic syndrome, these could even involve stimulation of inflammatory, immune or other systems, so the timing of intervention is important. With advances in supportive care in the intensive care unit, the ability to titrate treatment individually is becoming both a reality and a necessity. This important book brings together contributions from an international group of experts in diverse fields, including adaptive immunity, inflammation, neuroendocrinology, bioenergetics and metabolism, to consider all aspects of sepsis and its treatment. "The pattern of critical illness has changed, such that sepsis, multiple organ failure and impaired patient immunity now dominate clinical practice. Sadly, despite many therapeutic advances, the mortality of this complex syndrome remains high, posing a major challenge. This book highlights the complexity of the disorder and signals the directions for future therapeutic endeavour." Dr Jack Tinker, Emeritus Dean The Royal Society of Medicine, London