• U Müller-Werdan, J Wilhelm, S Hettwer, S Nuding, H Ebelt, and K Werdan.
• Universitätsklinik und Poliklinik für Innere Medizin III, Universitätsklinikum Halle (Saale) der Martin-Luther-Universität Halle-Wittenberg, Ernst-Grube-Strasse 40, 06120, Halle (Saale), Deutschland. ursula.mueller-werdan@medizin.uni-halle.de
• Internist (Berl). 2009 Jul 1;50(7):828, 830-2, 834-6, passim.

AbstractThis article deals with specific aspects of the patient with sepsis and his treatment. With adequate therapy (antibiotics started within the first hour, early goal-directed therapy) initiated as early as possible, the patient with community-aquired severe sepsis in the emergency department has a considerable better chance to survive than the patient with prolonged severe sepsis in the ICU. The average age of patients with severe sepsis and septic shock treated at the ICU is rising, with consequences like oligosymptomatic presentation, altered pharmakokinetics according to older-age-induced reduced organ functions and prolonged stay at the ICU due to comorbidity. Due to sexual dimorphisms of the immune system, women have a better prognosis in sepsis than men. In an animal sepsis model activation of the estrogen receptor beta improves prognosis. Within six months after having survived severe sepsis, morbidity and mortality is still increased. Taking care for the patient in a post-ICU outpatient department during this time will help to recognize these problems and to effectively treat the patient as soon as possible.

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