Role of endothelial injury and microcirculation in the pathophysiology of multiple organ dysfunction syndrome in adult patients with septic shock: A systematic review and meta-analysis
DOI:
https://doi.org/10.5281/zenodo.21544063Keywords:
sepsis, shock, septic, endothelial injury, microcirculation, multiple organ failure, biomarkersAbstract
Introduction: Sepsis and its most severe complication, septic shock, represent a critical challenge in intensive care medicine because of their high morbidity and mortality. Transition to multiple organ dysfunction syndrome (MODS) is considered the determinant event for prognosis, in which vascular injury plays a leading role.
Objective: To synthesize current scientific evidence on the impact of endothelial injury and microcirculatory dysfunction on the pathophysiology of MODS in adult patients with septic shock.
Methods: A systematic review was conducted following the PRISMA 2020 statement. The search covered databases including PubMed, Scopus, SciELO, LILACS and the Cochrane Library, including studies published between 2015 and 2025. Methodological quality was assessed using ROBINS-I, RoB 2 and AMSTAR 2 tools, and certainty of evidence with the GRADE system.
Results: Twenty highly relevant studies were included. Findings confirm that biomarkers of glycocalyx and endothelial injury (syndecan-1, VE-cadherin and angiopoietin-2) correlate directly with organ failure severity (SOFA scores) and short-term mortality. Likewise, persistent microvascular hypoperfusion, characterized by loss of hemodynamic coherence, acts as an independent predictor of mortality even after stabilization of macrohemodynamic parameters.
Conclusion: Dysfunction of the endothelium–microcirculation axis constitutes the pathogenic basis of MODS. Monitoring these parameters offers an early diagnostic window and underpins the development of therapeutic strategies aimed at vascular protection in critically ill patients.
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Copyright (c) 2026 Hugo Luís Fabiszáki Cordeiro, Stefany Nunes Matos, Rafael Lenz Carrie, Miguel Mottola De Oliveira Becegato, Matheus Steinmetz Weissheimer, Gabriel Hauari Maciel (Autor/a); Camila De Mello Pimentel (Traductor/a); Ana Flávia De Mello Barbosa Goulart, Aleksijane Cardoso da Silva, Stefany Oliveira da Silva , Andrea Paola Britos Gómez (Autor/a)
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