Why does the sepsis induced by severe COVID-19 have different clinical features from sepsis induced by CrKP?

I have read the present research report w让h great interest.This study attempted to explore the differences in sepsis caused by viral and bacterial infections by comparing the clinical features and prognosis of severe COVID-19 and carbapenem-resistant klebsiella pneumonia(CrKP).It is found that respiratory failure and immune suppression are more severe in COVID-19 cases,but systemic inflammatory responses and other systemic organ damages are less severe.Most COVID-19 sepsis is able to achieve a good prognosis.This study provides a rare opportunity for the understanding of sepsis caused by severe COVID-19.In this regard,1 would like to offer my views on some of the issues raised in the study.

Why anticoagulant studies on sepsis fail frequently-start with SCARLET

The Sepsis Coagulopathy Asahi Recombinant LE Thrombomodulin(SCARLET)trial has many defects,and thus cannot be the terminator of recombinant thrombomodulin(rTM).On the contrary,it provides sufficient evidence for further research.Based on analysis focusing on the failure of SCARLET and several previous anticoagulant studies,it is most important for new studies to grasp the following two points:(1)The enrolled cases should have sufficient disease severity and a clear standard for disseminated intravascular coagulation;(2)Heparin should not be used in combination with the investigated drugs.Multiple post-hoc analyses show that no combination of heparin will not increase the risk of thromboembolism.In fact,the combination of heparin can mask the true efficacy of the investigated drug.Due to the complexity of sepsis treatment and the limitations of clinical studies,the results of all treatment studies should be repeatedly verified,rather than be determined at one stroke.Some research conclusions contrary to disease physiology,pharmacology and clinical practice may be deceptive,and should be cautious rather than be simply accepted.On the other hand,the dissenting voices in the"consensus"scene are often well discussed by the authors and should be highly valued.

The severe COVID-19: A sepsis induced by viral infection? And its immunomodulatory therapy

COVID-19 is known for its magical infectivity,fast transmission and high death toll based on the large number of infected people.From the perspective of the clinical manifestation,autopsy examination and pathophysiology,the essence of COVID-19 should be viewed as a sepsis induced by viral infection,and has the essential characteristics as sepsis induced by other pathogens.Therefore,in addition to etiological and supportive treatment,immunomodulatory therapy is also appropriate to severe COVID-19.Although there is still a lack of consensus on immunotherapy for sepsis so far,relatively rich experiences have been accumulated in the past decades,which will help us in the treatment of severe COVID-19.This article will elaborate immunotherapy of sepsis,though it may not be consistent.

Why we need to revise the definition and diagnostic criteria for sepsis

In 2013,Vincent et al1 wrote for the Lancet to call for redefinition of sepsis,which aroused heated debates in medical fields and received very active response from related scholars.Why sepsis can attract so much attention? It is because sepsis can induce multiple organ failure and severely affect patients' prognosis.2-4 In the 1991 Chicago Consensus Conference,5 sepsis was simply defined as "the systemic response to infection has been termed sepsis."