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. 2020 Jun;46(6):1246-1248.
doi: 10.1007/s00134-020-06025-2. Epub 2020 Apr 8.

Noradrenaline drives immunosuppression in sepsis: clinical consequences

Roeland F Stolk  1   2   3 , Matthijs Kox  1   2 , Peter Pickkers  4   5
Affiliations

Noradrenaline drives immunosuppression in sepsis: clinical consequences

Roeland F Stolk et al. Intensive Care Med. 2020 Jun.
No abstract available

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Conflict of interest statement

The authors declare they have no competing interests.

Figures

Fig. 1
Fig. 1
Conceptual framework showing that, in sepsis patients, both disease severity and noradrenaline administration are important drivers of sepsis-induced immunosuppression. The development of immunosuppression is an intermediary factor, linking disease severity to adverse clinical outcomes. Several features of sepsis-induced immunosuppression are listed, as well as the consequences of immunosuppression, ultimately leading to impaired clinical outcome. As more severely ill sepsis patients are more likely to suffer from hemodynamic instability, anti-inflammatory effects of noradrenaline, mediated through the β-adrenoceptor, link disease severity to the development of immunosuppression. Therefore, noradrenaline represents an intermediary factor as well. This is of clinical relevance, because noradrenaline is a modifiable factor, which can be exploited for the prevention or treatment of sepsis-induced immunosuppression. Different approaches can be pursued, such as use of alternative vasopressors or concurrent administration of β-blockers. The current knowledge gaps that need to be bridged to explore this new concept are highlighted
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