Sepsis: Evidence-based pathogenesis and treatment

Figure 4 H₂O₂ induced immune system failure. Sequences 4A and 4B illustrate the common hypermetabolic response in infectious and non-infectious critical illness leading to H₂O₂ toxicity induced organ failure and sepsis. Lymphocytes are highly sensitive to H₂O₂ induced apoptosis. Lymphopenia is thus a manifestation of H₂O₂ induced immune system failure secondary to a hypermetabolic response in both infectious and non-infectious critical illness. H₂O₂ induced lymphopenia will predispose to de-novo infection in otherwise sterile critical illness and may cause a super-infection in patients on appropriate antibiotics. H₂O₂ toxicity and/or super-infection may contribute to sepsis mortality despite appropriate antibiotics.