Energetic dysfunction during sepsis

Abstract

Sepsis is characterised by a massive release of stress hormones and cytokines, which profoundly modify the body's metabolism, leading to an energy imbalance. An initial phase of metabolic attenuation allows the body to reprioritise energy expenditure in order to fight the infection. This is followed by hypermetabolism in surviving patients accompanying the cellular recovery processes. Intense catabolism is rapidly established in order to survive, drawing on energy reserves and altering the metabolism of carbohydrates, lipids and proteins. The mitochondria, the energy powerhouse of the vast majority of our cells, is profoundly damaged and plays a direct role in organ dysfunction and patient outcomes. Mitochondrial recovery depends on its quality control pathways, which are impaired in the extreme situations observed in the most severe patients. This review will discuss elements of metabolic physiology, then detail the metabolic disturbances induced by sepsis and finally discuss the involvement of mitochondria.