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Asociación entre la disfunción mitocondrial y la gravedad y resultado del shock séptico
David Brealey1, Michael Brand, Iain Hargreaves
1Bloomsbury Institute of Intensive Care Medicine, Wolfson Institute of Biomedical Research and Department of Medicine, University College London, London W1T 3AA, UK.
Lancet (London, England)
|July 23, 2002
Resumen
La sepsis causa disfunción mitocondrial y bajos niveles de ATP, vinculados a la insuficiencia de órganos y malos resultados. La sobreproducción de óxido nítrico y el agotamiento de antioxidantes contribuyen a esta falla bioenergética en pacientes en estado crítico.
Área de la Ciencia:
- Medicina de cuidados críticos Medicina de cuidados críticos.
- La bioquímica es la bioquímica.
- Fisiopatología Fisiopatología.
Sus antecedentes:
- La insuficiencia múltiple de órganos inducida por sepsis es una de las principales causas de muerte en pacientes en estado crítico.
- Los mecanismos de la disfunción de los órganos en la sepsis no se comprenden completamente.
- Los niveles elevados de oxígeno en los tejidos en la sepsis sugieren un deterioro en la utilización del oxígeno, posiblemente debido a una disfunción mitocondrial.
Objetivo del estudio:
- Para investigar el papel de la disfunción mitocondrial en la insuficiencia de órganos inducida por la sepsis.
- Explorar la asociación entre la producción de óxido nítrico, el estado antioxidante y la función mitocondrial en pacientes sépticos.
Principales métodos:
- Se realizaron biopsias del músculo esquelético en 28 pacientes sépticos en estado crítico y 9 controles sanos.
- El análisis incluyó la actividad de las enzimas de la cadena respiratoria (complejos I-IV), la concentración de ATP, la reducción del glutatión y los niveles de nitrito/nitrato.
Principales resultados:
- Los pacientes sépticos que murieron tenían concentraciones de ATP en el músculo esquelético significativamente más bajas que los sobrevivientes y los controles.
- La actividad del complejo I se correlacionó inversamente con la severidad del choque y los marcadores de óxido nítrico, y positivamente con los niveles reducidos de glutatión y ATP.
Conclusiones:
- Existe una asociación entre la sobreproducción de óxido nítrico, el agotamiento de antioxidantes, la disfunción mitocondrial y la reducción del ATP en pacientes sépticos.
- Estos factores se correlacionan con la insuficiencia orgánica y los resultados de los pacientes.
- La insuficiencia bioenergética está implicada como un mecanismo clave en la disfunción multiorgánico inducida por la sepsis.
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