PATHOLOGICAL FEATURES IN PATIENTS WITH SEPSIS – AN AUTOPSY STUDY

Authors

  • Elena-Roxana AVADANEI ‟Grigore Popa” University of Medicine and Pharmacy Iași
  • Irina-Draga CARUNTU ‟Grigore Popa” University of Medicine and Pharmacy Iași
  • Simona Eliza GIUSCA ‟Grigore Popa” University of Medicine and Pharmacy Iași
  • A. KNIELING ‟Grigore Popa” University of Medicine and Pharmacy Iași

Keywords:

SEPSIS, AUTOPSY, PATHOLOGICAL LESIONS

Abstract

Background and aim: Our study aims to evaluate the etiologic profile of lesions and morphologic changes identified in the pathology generating sepsis, and to establish the lesion pattern based on necropsy examination in correlation with relevant clinical and microbiological data. Materials and methods: The study group included 100 patients with a clinical diagnosis of sepsis who had died, of whom 41 required autopsies. Results: The sepsis was confirmed after completing macroscopic and histological examination of the organs during the autopsy. 18 patients (36.58%) had a severe septic pulmonary involvement, the macroscopic diagnosis of death for 15 of them being bronchopneumonia (83.33%). For 8 patients (19.51%), the septic injury was localized at meningocerebral level, another 4 patients presented intimal valvular injuries, sustaining the diagnosis of infectious endocarditis. The most common non-specific lesions were congestion of red pulp of spleen (85.36%), severe cerebral (78.04%) and pulmonary edema (58.53%), and disseminated intravascular coagulation syndrome (51.21%). Discussion: The autopsy confirmed a heterogeneity of specific and non-specific lesions, and no general lesion profile could be drawn. Antibiotics are the mainstay of sepsis therapy. However, antibiotics failed to control the main outbreak of infection, with subsequent sepsis leading to death. Conclusion: The identified pathological features delineated the landmarks of the septic lesion within the batch, emphasizing the severity of the single or associated lesions.

Author Biographies

  • Elena-Roxana AVADANEI, ‟Grigore Popa” University of Medicine and Pharmacy Iași

    Faculty of Medicine
    Department of Morpho-Functional Sciences (I) / Histology
    “Sfânta Parascheva” Clinical Hospital of Infectious Disease Iasi, Romania
    Department of Pathology

  • Irina-Draga CARUNTU, ‟Grigore Popa” University of Medicine and Pharmacy Iași

    Faculty of Medicine
    Department of Morpho-Functional Sciences (I) / Histology
    Romanian Academy of Medical Sciences, Bucharest, Romania

  • Simona Eliza GIUSCA, ‟Grigore Popa” University of Medicine and Pharmacy Iași

    Faculty of Medicine
    Department of Morpho-Functional Sciences (I) / Histology

  • A. KNIELING, ‟Grigore Popa” University of Medicine and Pharmacy Iași

    Faculty of Medicine
    Department of Medical Specialties (III) / Forensic Medicine

References

1. Singer M, Deutschman CS, Seymour CW, et al. The third International Consensus definitions for sepsis and septic shock (Sepsis-3). JAMA 2016; 315(8): 801-810 / doi:10.1001/jama. 2016. 0287.

2. Gatica S, Fuentes B, Rivera-Asín E, et al. Novel evidence on sepsis-inducing pathogens: from laboratory to bedside. Front Microbiol 2023; 14: 1198200 / doi:10.3389/fmicb.2023.1198200.

3. Rorat M, Jurek T, Simon K. Post-mortem diagnostics in cases of sepsis. Part 1. Etiology, epidemiology and microbiological tests. Arch Med Sadowej Kryminol 2014; 64(4): 280-294 / doi:10.5114/amsik.2014.50532.

4. Srzić I, Nesek Adam V, Tunjić Pejak D. Sepsis definition: what’s new in the treatment guidelines. Acta Clin Croat 2022; 61: 67-72 / doi:10.20471/acc.2022.61.s1.11.

5. Rhee C, Gohil S, Klompas M. Regulatory mandates for sepsis care-reasons for caution. N Engl J Med 2014; 370(18): 1673-1676 / doi:10.1056/NEJMp1400276.

6. Pomara C, Riezzo I, Bello S, et al. A pathophysiological insight into sepsis and its correlation with postmortem diagnosis. Mediators Inflamm 2016; 2016: 4062829 / doi:10.1155/ 2016/ 4062829.

7. Torgersen C, Moser P, Luckner G, et al. Macroscopic postmortem findings in 235 surgical intensive care patients with sepsis. Anesth Analg 2009; 108(6): 1841-1847. doi:10.1213/ane. 0b01 3e 318195e11d.

8. Tsokos M. Pathology of sepsis. Essentials of Autopsy Practice. 2006; 39-85 / doi:10.1007/1-84628-026-5_3.

9. Mukherjee T, Mukherjee S, Singh N, Singh A. Retrospective analysis of histopathological and microbiological correlation of autopsy series. J Clin Med Ther 2017; 2(2): 1-4.

10. Angus DC, Mayr FB, Yende S. Epidemiology of sever sepsis. Crit Care Med 2014; 5(1): 4-11.

11. Balica IM. Actualități etiopatogenice în sepsis. Arta Medicală 2006; 1(16): 33-41.

12. Jimenez MF, Marshall JC. International Sepsis Forum. Source control in the management of sepsis. Intensive Care Med 2001; 27: S49-S62 / doi:10.1007/pl00003797.

13. Dellinger RP, Levy MM, Carlet JM, et al. Surviving Sepsis Campaign: international guidelines for management of severe sepsis and septic shock: 2008. Crit Care Med 2008; 36(1): 296-327 / doi:10.1097/01.CCM.0000298158.12101.41.

14. Annane D, Bellissant E, Cavaillon JM. Septic shock. Lancet 2005; 365(9453): 63-78 / doi:10.1016/S0140-6736(04)17667-8.

15. Mort TC, Yeston NS. The relationship of pre-mortem diagnoses and post mortem findings in a surgical intensive care unit. Crit Care Med 1999; 27(2): 299-303 / doi:10.1097/00003246-199902000-00035.

16. Castellanos Ortega A, Ortiz Melón F, García Fuentes M, et al. Evaluación de la autopsia en la Unidad de Cuidados Intensivos Pediátricos [The evaluation of autopsy in the pediatric intensive unit]. An Esp Pediatr 1997; 46(3): 224-228.

17. Kobzik L. The lung. In: Cotran RS, Kumar V, Collins T, Robbins SL (eds). Robbins Pathologic Basis of Disease. 6th ed. Philadelphia: Saunders; 1999, 626-679.

18. Soeiro Ade M, Parra ER, Canzian M, et al. Pulmonary histopathological alterations in patients with acute respiratory failure: an autopsy study. J Bras Pneumol 2008; 34(2): 67-73 / doi: 10. 1590/s1806-37132008000200002.

19. Ebersoldt M, Sharshar T, Annane D. Sepsis-associated delirium. Intensive Care Med 2007; 33(6): 941-950 / doi:10.1007/s00134-007-0622-2.

20. Sharshar T, Annane D, de la Grandmaison GL, et al. The neuropathology of septic shock. Brain Pathol 2004; 14(1): 21-33 / doi:10.1111/j.1750-3639. 2004.tb00494.

21. Barichello T, Generoso JS, Dominguini D, et al. Postmortem evidence of brain inflammatory markers and injury in septic patients: systematic review. Crit Care Med 2022; 50(3): e241-e252 / doi:10.1097/CCM.000000000000530.

22. Khalil H, Soufi S. Prosthetic Valve Endocarditis. [Updated 2022 Dec 11]. In: StatPearls [Internet]. Treasure Island (FL): StatPearls Publishing; 2024 Jan-. Available from: https://www.ncbi.nlm.nih.gov/books/NBK567731/.

23. Clemente G, Tuttolomondo A, Colomba D, et al. When sepsis affects the heart: a case report and literature review. World J Clin Cases 2015; 3(8): 743-750 / doi:10.12998/wjcc.v3.i8.743.

24. Peerapornratana S, Manrique-Caballero CL, Gómez H, Kellum JA. Acute kidney injury from sepsis: current concepts, epidemiology, pathophysiology, prevention and treatment. Kidney Int 2019; 96(5): 1083-1099 / doi:10.1016/j.kint.2019.05.026.

Additional Files

Published

2024-12-23