Skip to main content

Advertisement

Log in

Acute Inflammation and Metabolism

  • REVIEW
  • Published:
Inflammation Aims and scope Submit manuscript

Abstract

Inflammation is an adaptive process to the noxious stimuli that the human body is constantly exposed to. From the local inflammatory response to a full-blown systemic inflammation, a wide complex sequence of events occurs. Persistent immunosuppression and catabolism may ensue, until multiple organ failure finally sets in. And since clinically useful and specific biomarkers are lacking, diagnosis may come late. A thorough understanding of these events (how they begin, how they evolve, and how to modulate them) is imperative, but as yet poorly studied. This review aims to consolidate current knowledge of these events so that the management of these patients is not only evidence-based, but also built on an understanding of the inner workings of the human body in health and in disease.

This is a preview of subscription content, log in via an institution to check access.

Access this article

Price excludes VAT (USA)
Tax calculation will be finalised during checkout.

Instant access to the full article PDF.

Fig. 1
Fig. 2
Fig. 3

Similar content being viewed by others

References

  1. Medzhitov, R. 2008. Origin and physiological roles of inflammation. Nature 454 (7203): 428–435.

    Article  PubMed  CAS  Google Scholar 

  2. Medzhitov, R. 2010. Inflammation 2010: new adventures of an old flame. Cell 140 (6): 771–776.

    Article  PubMed  CAS  Google Scholar 

  3. Mills K. 2011. TLR-dependent T cell activation in autoimmunity. Nature Reviews Immunology.

  4. Gando, S. 2010. Microvascular thrombosis and multiple organ dysfunction syndrome. Critical Care Medicine 38: S35–S42.

    Article  PubMed  Google Scholar 

  5. Serhan, C., P. Ward, and D. Gilroy. 2010. Fundamentals of inflammation. 1st ed. Cambridge: Cambridge University Press.

    Book  Google Scholar 

  6. Schwartz, R., H. Eltzschig, and P. Carmeliet. 2011. Hypoxia and inflammation. New England Journal of Medicine 364 (7): 656–665.

    Article  Google Scholar 

  7. Marik, P., and R. Bellomo. 2013. Lactate clearance as a target of therapy in sepsis: a flawed paradigm. OA Critical Care 1 (1).

  8. Mittal, M., M. Siddiqui, K. Tran, S. Reddy, and A. Malik. 2014. Reactive oxygen species in inflammation and tissue injury. Antioxidants & Redox Signaling 20 (7): 1126–1167.

    Article  CAS  Google Scholar 

  9. Griffiths, H., D. Gao, and C. Pararasa. 2017. Redox regulation in metabolic programming and inflammation. Redox Biology 12: 50–57.

    Article  PubMed  PubMed Central  CAS  Google Scholar 

  10. Atsumi, T., Y. Cho, L. Leng, C. McDonald, T. Yu, C. Danton, et al. 2007. The proinflammatory cytokine macrophage migration inhibitory factor regulates glucose metabolism during systemic inflammation. The Journal of Immunology 179 (8): 5399–5406.

    Article  PubMed  CAS  Google Scholar 

  11. Bach, E., R. Nielsen, M. Vendelbo, A. Moller, N. Jessen, M. Buhl, et al. 2013. Direct effects of TNF-α on local fuel metabolism and cytokine levels in the placebo-controlled, bilaterally infused human leg: increased insulin sensitivity, increased net protein breakdown, and increased IL-6 release. Diabetes 62 (12): 4023–4029.

    Article  PubMed  PubMed Central  CAS  Google Scholar 

  12. Bayir, H., and V. Kagan. 2008. Bench-to-bedside review: mitochondrial injury, oxidative stress and apoptosis—there is nothing more practical than a good theory. Critical Care 12 (1): 206.

    Article  PubMed  PubMed Central  Google Scholar 

  13. Tafani, M., L. Sansone, F. Limana, T. Arcangeli, E. De Santis, M. Polese, et al. 2016. The interplay of reactive oxygen species, hypoxia, inflammation, and sirtuins in cancer initiation and progression. Oxidative Medicine and Cellular Longevity 2016: 1–18.

    Article  CAS  Google Scholar 

  14. Tisoncik, J., M. Korth, C. Simmons, J. Farrar, T. Martin, and M. Katze. 2012. Into the eye of the cytokine storm. Microbiology and Molecular Biology Reviews 76 (1): 16–32.

    Article  PubMed  CAS  Google Scholar 

  15. Gruys, E., M. Toussaint, T. Niewold, and S. Koopmans. 2005. Acute phase reaction and acute phase proteins. Journal of Zhejiang University SCIENCE 6B (11): 1045–1056.

    Article  CAS  Google Scholar 

  16. Firestein G, Gabriel S, McInnes I, O’Dell J. 2016. Kelley and Firestein’s textbook of rheumatology. 10th ed. Elsevier.

  17. Rolfes S, Pinna K, Whitney E. 2014. Understanding normal and clinical nutrition. 10th ed. Brooks Cole.

  18. Meisner, M. 2014. Update on procalcitonin measurements. Annals of Laboratory Medicine 34 (4): 263.

    Article  PubMed  PubMed Central  CAS  Google Scholar 

  19. Peitzman A, Schwab C, Yealy D, Rhodes M, Fabian T. 2012. Trauma Manual. 4th ed. Wolters Kluwer Health.

  20. Haschek W, Wallig M, Rousseaux C. 2009. Fundamentals of toxicologic pathology. 2nd ed. Academic Press. 51–54.

  21. Preiser, J., C. Ichai, J. Orban, and A. Groeneveld. 2014. Metabolic response to the stress of critical illness. British Journal of Anaesthesia 113 (6): 945–954.

    Article  PubMed  CAS  Google Scholar 

  22. Vanhorebeek, I., and G. Van den Berghe. 2006. The neuroendocrine response to critical illness is a dynamic process. Critical Care Clinics 22 (1): 1–15.

    Article  PubMed  CAS  Google Scholar 

  23. Nylen, E., and B. Muller. 2004. Endocrine changes in critical illness. Journal of Intensive Care Medicine 19 (2): 67–82.

    Article  PubMed  Google Scholar 

  24. Townsend C, Beauchamp R, Evers B, Mattox K. 2016. Sabiston textbook of surgery. 20th ed. Elsevier.

  25. Dickerson, R. 2016. Nitrogen balance and protein requirements for critically ill older patients. Nutrients 8 (4): 226.

    Article  PubMed  PubMed Central  CAS  Google Scholar 

  26. Casaer, M., and G. Van den Berghe. 2014. Nutrition in the acute phase of critical illness. New England Journal of Medicine 370 (13): 1227–1236.

    Article  PubMed  CAS  Google Scholar 

  27. Rooyackers, O., M. Sundström Rehal, F. Liebau, Å. Norberg, and J. Wernerman. 2017. High protein intake without concerns? Critical Care 21 (1).

  28. Stahel, P., M. Flierl, and E. Moore. 2010. “Metabolic staging” after major trauma—a guide for clinical decision making? Scandinavian Journal of Trauma, Resuscitation and Emergency Medicine 18 (1): 34.

    Article  PubMed  PubMed Central  Google Scholar 

  29. Pravda, J. 2014. Metabolic theory of septic shock. World Journal of Critical Care Medicine 3 (2): 45–54.

    Article  PubMed  PubMed Central  Google Scholar 

  30. De Backer, D., J. Ortiz, and D. Salgado. 2010. Coupling microcirculation to systemic hemodynamics. Current Opinion in Critical Care 16 (3): 250–254.

    Article  PubMed  Google Scholar 

  31. El-Menyar, A., H. Thani, E. Zakaria, A. Zarour, M. Tuma, H. AbdulRahman, et al. 2012. Multiple organ dysfunction syndrome (MODS): is it preventable or inevitable? International Journal of Clinical Medicine 3 (7): 722–730.

    Article  Google Scholar 

  32. Marino P. The ICU book. 4th ed. Lippincott Williams & Wilkins.

  33. Hayden, S., T. Albert, T. Watkins, and E. Swenson. 2012. Anemia in critical illness. American Journal of Respiratory and Critical Care Medicine 185 (10): 1049–1057.

    Article  PubMed  PubMed Central  Google Scholar 

  34. Gunst, J. 2017. Recovery from critical illness-induced organ failure: the role of autophagy. Critical Care 21 (1).

  35. Ling, H., H. Chen, M. Wei, X. Meng, Y. Yu, and K. Xie. 2015. The effect of autophagy on inflammation cytokines in renal ischemia/reperfusion injury. Inflammation 39 (1): 347–356.

    Article  CAS  Google Scholar 

  36. Simsek, T., H. Uzelli Simsek, and N. Canturk. 2014. Response to trauma and metabolic changes: posttraumatic metabolism. Turkish Journal of Surgery 30 (3): 153–159.

    Article  PubMed  Google Scholar 

  37. Rousseau, A., M. Losser, C. Ichai, and M. Berger. 2013. ESPEN endorsed recommendations: nutritional therapy in major burns. Clinical Nutrition 32 (4): 497–502.

    Article  PubMed  Google Scholar 

  38. Lewis S, Dirksen S, Heitkemper M, Bucher L. 2013. Medical-surgical nursing: assessment and management of clinical problems. 9th ed. Mosby.

  39. Dellinger, R., M. Levy, J. Carlet, J. Bion, M. Parker, R. Jaeschke, et al. 2007. Surviving sepsis campaign: international guidelines for management of severe sepsis and septic shock: 2008. Intensive Care Medicine 34 (1): 17–60.

    Article  PubMed  PubMed Central  Google Scholar 

  40. Binkowska, A., G. Michalak, and R. Słotwiński. 2015. Current views on the mechanisms of immune responses to trauma and infection. Central European Journal of Immunology 2: 206–216.

    Article  CAS  Google Scholar 

  41. Kylänpää, M. 2010. Inflammation and immunosuppression in severe acute pancreatitis. World Journal of Gastroenterology 16 (23): 2867.

    Article  PubMed  PubMed Central  CAS  Google Scholar 

  42. Comstedt, P., M. Storgaard, and A. Lassen. 2009. The systemic inflammatory response syndrome (SIRS) in acutely hospitalised medical patients: a cohort study. Scandinavian Journal of Trauma, Resuscitation and Emergency Medicine 17 (1): 67.

    Article  PubMed  PubMed Central  Google Scholar 

  43. Freund, Y., N. Lemachatti, E. Krastinova, M. Van Laer, Y. Claessens, A. Avondo, et al. 2017. Prognostic accuracy of Sepsis-3 criteria for in-hospital mortality among patients with suspected infection presenting to the emergency department. Journal of the American Medical Association 317 (3): 301.

    Article  PubMed  Google Scholar 

  44. Reintam Blaser, A., M. Malbrain, J. Starkopf, S. Fruhwald, S. Jakob, J. De Waele, et al. 2012. Gastrointestinal function in intensive care patients: terminology, definitions and management. Recommendations of the ESICM Working Group on Abdominal Problems. Intensive Care Medicine 38 (3): 384–394.

    Article  PubMed  PubMed Central  Google Scholar 

  45. Cameron J, Cameron A. 2016. Current surgical therapy. 12th ed. Elsevier.

  46. de Montmollin, E., and D. Annane. 2011. Year in review 2010: critical care—multiple organ dysfunction and sepsis. Critical Care 15 (6): 236.

    Article  PubMed  PubMed Central  Google Scholar 

  47. Torres, D., R. Stevens, and A. Gurakar. 2010. Acute liver failure: a management challenge for the practicing gastroenterologist. Gastroenterology & Hepatology 6 (7): 444–450.

    Google Scholar 

  48. Nesseler, N., Y. Launey, C. Aninat, F. Morel, Y. Mallédant, and P. Seguin. 2012. Clinical review: the liver in sepsis. Critical Care 16 (5): 235.

    Article  PubMed  PubMed Central  Google Scholar 

  49. Lee W, Larson A, Stravitz R. 2011. AASLD position paper: the management of acute liver failure: Update 2011. Hepatology 55(3).

  50. Joannidis, M., W. Druml, L. Forni, A. Groeneveld, P. Honore, E. Hoste, et al. 2017. Prevention of acute kidney injury and protection of renal function in the intensive care unit: update 2017. Intensive Care Medicine 43 (6): 730–749.

    Article  PubMed  PubMed Central  CAS  Google Scholar 

  51. Post, E., J. Kellum, R. Bellomo, and J. Vincent. 2017. Renal perfusion in sepsis: from macro- to microcirculation. Kidney International 91 (1): 45–60.

    Article  PubMed  Google Scholar 

  52. Gentile, L., A. Cuenca, P. Efron, D. Ang, A. Bihorac, B. McKinley, et al. 2012. Persistent inflammation and immunosuppression. Journal of Trauma and Acute Care Surgery 72 (6): 1491–1501.

    Article  PubMed  CAS  Google Scholar 

  53. Husain-Syed, F., P. McCullough, H. Birk, M. Renker, A. Brocca, W. Seeger, et al. 2015. Cardio-pulmonary-renal interactions. Journal of the American College of Cardiology 65 (22): 2433–2448.

    Article  PubMed  CAS  Google Scholar 

  54. Lane, K., J. Dixon, I. MacPhee, and B. Philips. 2013. Renohepatic crosstalk: does acute kidney injury cause liver dysfunction? Nephrology Dialysis Transplantation 28 (7): 1634–1647.

    Article  Google Scholar 

  55. Acevedo, J., and M. Cramp. 2017. Hepatorenal syndrome: update on diagnosis and therapy. World Journal of Hepatology 9 (6): 293.

    Article  PubMed  PubMed Central  Google Scholar 

  56. Park, S., M. Kim, K. Brown, V. D’Agati, and H. Lee. 2011. Paneth cell-derived interleukin-17A causes multiorgan dysfunction after hepatic ischemia and reperfusion injury. Hepatology 53 (5): 1662–1675.

    Article  PubMed  PubMed Central  CAS  Google Scholar 

  57. Puthucheary, Z., J. Rawal, M. McPhail, B. Connolly, G. Ratnayake, P. Chan, et al. 2013. Acute skeletal muscle wasting in critical illness. Journal of the American Medical Association 310 (15): 1591.

    Article  PubMed  CAS  Google Scholar 

  58. McClave, S., B. Taylor, R. Martindale, M. Warren, D. Johnson, C. Braunschweig, et al. 2016. Guidelines for the provision and assessment of nutrition support therapy in the adult critically ill patient. Journal of Parenteral and Enteral Nutrition 40 (2): 159–211.

    Article  PubMed  CAS  Google Scholar 

  59. Wilson W, Grande C, Hoyt D. 2007. Trauma: critical care (Volume 2). 1st ed. CRC Press.

  60. Rosenthal, M. D., F. A. Moore. 2015. Persistent inflammatory, immunosuppressed, catabolic syndrome (PICS): a new phenotype of multiple organ failure. Journal of Advanced Nutrition and Human Metabolism 1 (1): e784. https://doi.org/10.14800/janhm.784.

    Google Scholar 

  61. Ward, N., B. Casserly, and A. Ayala. 2008. The compensatory anti-inflammatory response syndrome (CARS) in critically ill patients. Clinics in Chest Medicine 29 (4): 617–625.

    Article  PubMed  PubMed Central  Google Scholar 

  62. Sauaia, A., F. Moore, and E. Moore. 2017. Postinjury inflammation and organ dysfunction. Critical Care Clinics 33 (1): 167–191.

    Article  PubMed  PubMed Central  Google Scholar 

  63. Cederholm, T., R. Barazzoni, P. Austin, P. Ballmer, G. Biolo, S. Bischoff, et al. 2017. ESPEN guidelines on definitions and terminology of clinical nutrition. Clinical Nutrition 36 (1): 49–64.

    Article  PubMed  CAS  Google Scholar 

  64. Pepys, M., and G. Hirschfield. 2003. C-reactive protein: a critical update. Journal of Clinical Investigation 112 (2): 299–299.

    Article  PubMed Central  CAS  Google Scholar 

  65. Sellés A. 2014. Biomarcadores en el paciente crítico. 1st ed, 17–27 Edikamed.

  66. Barraud, D., and S. Gibot. 2011. Triggering receptor expressed on myeloid cell 1. Critical Care Clinics 27 (2): 265–279.

    Article  PubMed  CAS  Google Scholar 

  67. Rhodes, A., L. Evans, W. Alhazzani, M. Levy, M. Antonelli, R. Ferrer, et al. 2017. Surviving sepsis campaign: international guidelines for management of sepsis and septic shock: 2016. Intensive Care Medicine 43 (3): 304–377.

    Article  PubMed  Google Scholar 

  68. Sellés A. 2014. Biomarcadores en el paciente crítico. 1st ed, 51–62. Edikamed.

  69. Cicarelli, D., J. Vieira, and F. Benseñor. 2007. Lactate as a predictor of mortality and multiple organ failure in patients with the systemic inflammatory response syndrome. Revista Brasileira de Anestesiologia 57 (6): 630–638.

    PubMed  CAS  Google Scholar 

  70. Mackay, A., J. Erskine, O. Kerr, L. Marshall, and A. Davidson. 2010. C-reactive protein and albumin as prognostic markers in intensive care. Critical Care 14 (Suppl 1): 430.

    Article  Google Scholar 

  71. Gundpatil, D., B. Somani, T. Saha, and M. Banerjee. 2012. Serum urea: albumin ratio as a prognostic marker in critical patients with non-chronic kidney disease. Indian Journal of Clinical Biochemistry 29 (1): 97–100.

    Article  PubMed  PubMed Central  CAS  Google Scholar 

  72. Moraes, R., M. Czepielewski, G. Friedman, and E. Borba. 2011. Diagnosis of adrenal failure in critically ill patients. Arquivos Brasileiros de Endocrinologia & Metabologia 55 (5): 295–302.

    Article  Google Scholar 

  73. Lee, S., and A. Farwell. 2016. Euthyroid sick syndrome. Comprehensive Physiology 6 (2): 1071–1080.

    Article  PubMed  Google Scholar 

  74. Umpierrez, G., and F. Pasquel. 2017. Management of inpatient hyperglycemia and diabetes in older adults. Diabetes Care 40 (4): 509–517.

    Article  PubMed  PubMed Central  Google Scholar 

  75. Jacobi, J., N. Bircher, J. Krinsley, M. Agus, S. Braithwaite, C. Deutschman, et al. 2012. Guidelines for the use of an insulin infusion for the management of hyperglycemia in critically ill patients. Critical Care Medicine 40 (12): 3251–3276.

    Article  PubMed  Google Scholar 

  76. Toulson Davisson Correia, M., and R. da Silva. 2004. The impact of early nutrition on metabolic response and postoperative ileus. Current Opinion in Clinical Nutrition and Metabolic Care. 7 (5): 577–583.

    Article  Google Scholar 

  77. Astin, R., and Z. Puthucheary. 2014. Anaemia secondary to critical illness: an unexplained phenomenon. Extreme Physiology & Medicine 3 (1): 4.

    Article  Google Scholar 

  78. Rawal, G., R. Kumar, S. Yadav, and A. Singh. 2016. Anemia in intensive care: a review of current concepts. The Journal of Critical Care Medicine 2 (3).

  79. Walsh, T. 2006. Anaemia during critical illness. British Journal of Anaesthesia 97 (3): 278–291.

    Article  PubMed  CAS  Google Scholar 

  80. Cullis, J. 2011. Diagnosis and management of anaemia of chronic disease: current status. British Journal of Haematology 154 (3): 289–300.

    Article  PubMed  Google Scholar 

  81. Oustamanolakis, P., I. Koutroubakis, I. Messaritakis, M. Niniraki, and E. Kouroumalis. 2011. Soluble transferrin receptor-ferritin index in the evaluation of anemia in inflammatory bowel disease: a case-control study. Annals of Gastroenterology 24 (2): 108–114.

    PubMed  PubMed Central  Google Scholar 

  82. Rehu, M., S. Ahonen, and K. Punnonen. 2011. The diagnostic accuracy of the percentage of hypochromic red blood cells (%HYPOm) and cellular hemoglobin in reticulocytes (CHr) in differentiating iron deficiency anemia and anemia of chronic diseases. Clinica Chimica Acta 412 (19–20): 1809–1813.

    Article  CAS  Google Scholar 

  83. Approach to the Diagnosis and Management of the Anemia of Chronic Inflammation [Internet]. Hematology.org. 2017 [cited 29 August 2017]. Available from: http://www.hematology.org/Thehematologist/Ask/6329.aspx.

  84. Rodriguez, R., H. Corwin, A. Gettinger, M. Corwin, D. Gubler, and R. Pearl. 2001. Nutritional deficiencies and blunted erythropoietin response as causes of the Amemia of critical illness. Journal of Critical Care 16 (1): 36–41.

    Article  PubMed  CAS  Google Scholar 

  85. Weiss, G., and L. Goodnough. 2005. Anemia of chronic disease. The New England Journal of Medicine 352 (10): 1011–1023.

    Article  PubMed  CAS  Google Scholar 

  86. Pazarli, P., T. Yarkin, Z. Karakurt, D. Yetis, C. Saltürk, B. Celik, et al. 2007. Follow-up hemoglobin concentrations in ICU: relationship between diagnostic blood loss and daily fluid balance. Tüberküloz ve Toraks 55 (4): 323–328.

    PubMed  Google Scholar 

  87. Dahlin, C., P. Coyne, and B. Ferrell. 2016. Advanced practice palliative nursing. 1st ed, 479–486. New York: Oxford University Press.

    Book  Google Scholar 

Download references

Author information

Authors and Affiliations

Authors

Corresponding author

Correspondence to Miguel Lourenço Varela.

Ethics declarations

Competing Interests

The authors declare that they have no competing of interest.

Rights and permissions

Reprints and permissions

About this article

Check for updates. Verify currency and authenticity via CrossMark

Cite this article

Varela, M.L., Mogildea, M., Moreno, I. et al. Acute Inflammation and Metabolism. Inflammation 41, 1115–1127 (2018). https://doi.org/10.1007/s10753-018-0739-1

Download citation

  • Published:

  • Issue Date:

  • DOI: https://doi.org/10.1007/s10753-018-0739-1

KEY WORDS

Navigation