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A unifying hypothesis of multiple systems organ failure: Failure of host defense homeostasis

Pinsky, MR and Matuschak, GM (1990) A unifying hypothesis of multiple systems organ failure: Failure of host defense homeostasis. Journal of Critical Care, 5 (2). 108 - 114. ISSN 0883-9441

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Multiple systems organ failure (MSOF) represents the culmination of a process of progressive remote organ system dysfunction that evolves following numerous forms of critical illness. The process is pathogenstically related to sepsis; if a septic nidus exists and is not eradicated, organs remote from the initial site of tissue injury fail and the disease process ultimately ends in death. We hypothesize that the underlying process is an uncontrolled (malignant) intravascular inflammatory response, usually to a septic challenge. Dysfunction of individual organs appears to be less important than global cellular function. Thus, single organ-directed treatments during systemic sepsis do little to reverse the process that initially created the organ dysfunction. Since the liver plays a central role in host-defense homeostasis, its performance is primary in determining the systemic expression of MSOF and its outcome. Both the level of intravascular inflammation and its duration may be equally important in the development of MSOF. Accordingly, therapeutic strategies that minimize the systemic nature of the host inflammatory response, while eradicating the stimulus and maintaining tissue viability, should be more successful at improving survival in MSOF than the present organ-specific approach. © 1990.


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Item Type: Article
Status: Published
CreatorsEmailPitt UsernameORCID
Pinsky, MRpinsky@pitt.eduPINSKY0000-0001-6166-700X
Matuschak, GM
Date: 1 January 1990
Date Type: Publication
Journal or Publication Title: Journal of Critical Care
Volume: 5
Number: 2
Page Range: 108 - 114
DOI or Unique Handle: 10.1016/0883-9441(90)90056-f
Schools and Programs: School of Medicine > Critical Care Medicine
Refereed: Yes
ISSN: 0883-9441
Article Type: Review
Date Deposited: 25 Aug 2012 16:59
Last Modified: 30 Jan 2020 16:55


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