Modelling the dynamic interaction of systemic inflammation and the hypothalamic–pituitary–adrenal (HPA) axis during and after cardiac surgery
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Le résumé fourni par la source
Major surgery and critical illness produce a potentially life-threatening systemic inflammatory response. The hypothalamic-pituitary-adrenal (HPA) axis is one of the key physiological systems that counterbalances this systemic inflammation through changes in adrenocorticotrophic hormone (ACTH) and cortisol. These hormones normally exhibit highly correlated ultradian pulsatility with an amplitude modulated by circadian processes. However, these dynamics are disrupted by major surgery and critical illness. In this work, we characterize the inflammatory, ACTH and cortisol responses of patients undergoing cardiac surgery and show that the HPA axis response can be classified into one of three phenotypes: single-pulse, two-pulse and multiple-pulse dynamics. We develop a mathematical model of cortisol secretion and metabolism that predicts the physiological mechanisms responsible for these different phenotypes. We show that the effects of inflammatory mediators are important only in the single-pulse pattern in which normal pulsatility is lost-suggesting that this phenotype could be indicative of the greatest inflammatory response. Investigating whether and how these phenotypes are correlated with clinical outcomes will be critical to patient prognosis and designing interventions to improve recovery.
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Le contrôle bibliographique ouvert
DOI retrouvé dans Crossref DOI retrouvé ; titre concordant.
- Titre Crossref
- Modelling the dynamic interaction of systemic inflammation and the hypothalamic–pituitary–adrenal (HPA) axis during and after cardiac surgery
- Date Crossref
- 01/04/2022
- Éditeur
- The Royal Society
- Type
- journal-article
Ce recoupement confirme des métadonnées liées au DOI. Il ne confirme ni la méthode ni les conclusions de l’étude, et il ne compte pas comme une seconde source scientifique indépendante.
Où se fait cette recherche
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University of Birmingham Centre for Systems Modelling and Quantitative Biomedicine (SMQB) pays non établi dans la noticeUniversité ou école supérieure
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University of Exeter pays non établi dans la noticeUniversité ou école supérieure
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University of Bristol Henry Wellcome Laboratories for Integrative Neuroscience and Endocrinology pays non établi dans la noticeUniversité ou école supérieure
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University Hospitals Bristol NHS Foundation Trust Department of Pathology pays non établi dans la noticeÉtablissement de santé
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College of Engineering pays non établi dans la noticeUniversité ou école supérieure
Centre for Systems Modelling and Quantitative Biomedicine (SMQB) — University of Birmingham, University of Exeter et Henry Wellcome Laboratories for Integrative Neuroscience and Endocrinology — University of Bristol, avec 2 autres affiliations.
Une affiliation ne permet pas de déduire la nationalité d’un auteur.