Copyright ©The Author(s) 2020.
World J Hepatol. Aug 27, 2020; 12(8): 451-474
Published online Aug 27, 2020. doi: 10.4254/wjh.v12.i8.451
Table 1 Modification of sequential organ failure assessment score for patients with cirrhosis, the chronic liver failure-sequential organ failure assessment scoring system[13,15]
Respiration PaO2/FiO2 or SpO2/FiO2, mmHg> 300 to ≤ 400 or > 357 to ≤ 512> 200 to ≤ 300 or > 214 to ≤ 357> 100 to ≤ 200 or 89 to ≤ 214< 100 or ≤ 89
Liver bilirubin, mg/dL1.2-1.92.0-5.96.0-11.9> 12
Cardiovascular hypotensionMean arterial pressure < 70 mmHgDopamine ≤ 5 or any dobutamine or terlipressinDopamine > 5 or noradrenaline ≤ 0.1Dopamine > 15 or noradrenaline > 0.1
Cerebral HE gradesIIIIIIIV
Renal creatinine (mg/dL) or urine output1.2-1.92.0-3.43.5-4.9 or use of renal replacement therapy≥ 5.0
Coagulation - INR≥ 1.1 to < 1.25≥ 1.25 to < 1.5≥ 1.5 to < 2.5≥ 2.5 or platelet count ≤ 20000/µL
Table 2 Transcriptomics based micro assays for diagnosis of sepsis[57]
Assay name (manufacturer)Technique/sample volumeTurn-around timeHighest noted sensitivity and specificityDetection
SeptiFast (Roche)Real-time PCR/1.5 mL4 h to 6 h83%/95%> 16 bacteria, Candida and Aspergillus fumigatus
SeptiTest (Molzyme)Universal PCR/1 mL8 h to 10 h87%/96%> 345 bacteria and 13 fungi
SeptiCyte (ImmuneExpress)RT-qPCR with machine learning/2.5 mL1 h to 6 h-/ 95% (discriminates SIRS from sepsis)All pathogens
Iridica Plex ID (Abbott)Multiplex broad range PCR/5 mL6 h83%/94%780 bacteria and Candida
MinION (Oxford Nanopore)Nanopore sequencing/10 ng DNA4 h to 6 h-/100%Few viruses and bacteria currently
U-dHRM (UCSD, United States)Digital PCR/1 mL3 h-/99.9%37 bacteria
LAMP TechLoop mediated isothermal amplification/30 µL1 h-/100%1 pathogen per sample
Integrated droplet digital detection tech (Velox Biosystems)DNA-zyme base sensor droplet microencapsulation 3D particle analysis1 h to 4 h-1 pathogen per sample
Table 3 The modified early warning scoring system for identification of sepsis[63]
Respiratory rate per min≤ 89-1415-2021-29> 29
Heart rate per min≤ 4041-5051-100101-110111-129> 129
Systolic blood pressure, mmHg≤ 7071-8081-100101-199≥ 200
Urine output, mL/(kg·h)Nil< 0.5
Temperature, °C≤ 3535.1-3636.1-3838.1-38.5≥ 38.6
Neurological, subjectiveAlertReacting to voiceReacting to painUnresponsive
Table 4 Novel adjuvant therapies for management of sepsis[74-76]
TherapyMechanismSystemic effect in sepsis
Eritoran; resatorvidToll-like receptor 4 antagonist; Eritoran is structurally similar to lipopolysaccharide – A of Gram-negative bacteria. Resatorvid is a direct antagonist of toll like receptor 4Anti-inflammatory; Immunomodulation
Polymixin B fibre column; CytoSorbHemoperfusion; CytoSorb has hemadsorption propertiesRemoval of circulating endotoxin and bacterial components
Plasma exchange; Whole blood exchange; Coupled plasma filtration adsorption; HemofiltrationExchange of plasma or blood with or without sorbent adsorption; either continuous or intermittent; low or high volumeRemoval of endotoxins and circulating cytokines
MacrolidesNuclear factor kB and AP-1 signalling suppression, inhibition of ERK-1 and 2 pathwaysAnti-inflammatory and immunomodulating properties
Interferon-gammaIncrease in monocyte HLA-DR expressionRestores immune regulation, abolishes immunoparalysis by restoring monocyte function
ImmunoglobulinsIncrease in IgA and IgM levelsBoosts humoral immunity
Granulocyte macrophage colony stimulating factorPromotes maturation and differentiation of neutrophils, monocytes, macrophages, dendritic cells, T lymphocytes and plasma cellsImproves immune regulation, reduces immunoparalysis
Anti-MIFAntagonizes macrophage migration inhibition factorImmunomodulation through boosting activity of endogenous glucocorticoids
Super-Antigen-AntagonistSuppression of pro-inflammatory gene expression by inhibition of T cell activationTh1 blockade and prevention of lethal shock
Heparin and its analoguesAnti-thrombotic, immunomodulationPrevents early disseminated intravascular coagulation, prevents early organ failures due to diffuse system microvascular thrombosis
NaloxoneOpioid receptor antagonismImproves hemodynamic instability
PentoxifyllineDecreases erythrocyte aggregation and deformability, anti TNF-alpha effectImprovement in arterial oxygen tension by improving fractionated oxygen exchange
GTS-21Selective alpha-7-nicotinic acetylcholine receptor agonist, blocks nuclear factor – kB and cytokines downstreamActivates cholinergic anti-inflammatory pathway
Interleukin 7 and 2Pro-inflammatory cytokinesPrevents immunoparalysis
Programmed cell death-1 (PD-1) and ligand (PD-L1) antagonistPrevention of lymphocyte depletion, improvement in pro-inflammatory mediators and increased bacterial clearanceImmune modulation
B and T cell lymphocyte attenuator antagonism (BTLA)Increases activity and proliferation of T cellsIncreases resistance to endotoxin and prevention of endotoxin mediated shock
Antagonism of cytotoxic T lymphocyte antigen 4 (CTLA-4)Increased activity and proliferation of T cellsAbolishes endotoxemia and associated toxic shock
MethylthiouracilSuppresses high mobility group box – 1 (HMGB-1)Anti-inflammatory
Structurally nanoengineered antimicrobial peptide polymers; Ceria – zirconia nanoparticles; Piceatannol-loaded albumin nanoparticles; Sialic-acid decorated nanoparticles; Exsosomes loaded with MFGE8, miR-223; Red blood cells and macrophage coated nanoparticles; Liposomes tagged to antimicrobials; Opsonin bound magnetic nanobeadsNanoparticle technology (pre-clinical studies)Antibacterial; Antioxidant; Anti-inflammatory; Endotoxin antagonist; Extracorporeal blood cleansing; Clearance of apoptotic cells