Information Significance of the qSOFA Scale for Current Clinical Medicine. Literature Review

V.A. Rudnov1,2, M.A. Astafeva2

1 Federal State Budgetary Educational Institution of Further Professional Education “Ural state medical university” Ministry of healthcare of the Russian Federation, Yekaterinburg

2 Municipal autonomic health care institution “City Clinical Hospital No. 40”, Yekaterinburg

For correspondence: Rudnov Vladimir Aleksandrovich — Dr. Med. Sci., Professor, Head of the Department of Anesthesiology, Reanimatology and Toxicology, UGMU, Deputy Chief Physician for Anaesthesiology and Reanimatology, MAU GKB No. 40, Ekaterinburg; e-mail:

For citation: Rudnov V.A., Astafeva M.A. Information significance of the qSOFA scale for current clinical medicine. Literature review. Alexander Saltanov Intensive Care Herald. 2018;4:30–37.

DOI: 10.21320/1818-474X-2018-4-30-37

Active development of resuscitation and intensive care, establishment of departments and established clinical practice to understand the extreme heterogeneity of patients in critical conditions. One of the tools to reduce the number of errors and make an informed decision, depending on the situation. One of the shortcomings in the consciousness of scoring systems is their relative unwieldiness, the need for mandatory implementation of certain laboratory studies, which requires additional equipment and time. Therefore, attempts were made to create values based on clinical criteria or minimums. To such belongs the “early alarm” scale of the rapid SOFA.

The purpose of this publication was to assess the information significance of the qSOFA scale and determine its role for emergency and critical states, through analysis of literature data.

Conclusion. The qSOFA scale is designed to determine the risk of developing organ-system dysfunction, predicting the outcome of a critical condition and determining the location of the treatment delivery, not inferior to the sensitivity syndrome of the SVR, with respect to the prognosis of the outcome of sepsis in pacities with suspected infection, significantly exceeds its specificity.

Keywords: qSOFA scale, prognosis outcome, lactate, procalcitonin

Received: 19.10.2018

Read in PDF


  1. Saklad M. Grading of patients for surgical procedures. Anesthesiology. 1941; 2(3): 281–284. DOI: 10.1097/00000542-194105000-00004.
  2. New classification of physical status. Anesthesiology. 1963; 24(1): 111.
  3. Apgar V. A proposal for a new method of evaluation of the newborn infant. Anesthesia and Analgesia. 1953; 32: 260–267. DOI: 10.1213/00000539-195301000-00041.
  4. Knaus W., Zimmerman J., Wagner D., et al. APACHE-acute physiology and chronic health evaluation: a physiologically based classification system. Critical Care Medicine. 1981; 9(8): 591–597. DOI: 10.1097/00003246-198108000-00008.
  5. Knaus W.A., Draper E.A., Wagner D.P., Zimmerman J.E. APACHE II: A severity of disease classification system. Critical Care Medicine. 1985; 13(10): 818–829. DOI: 10.1097/00003246-198510000-00009.
  6. Le Gall J.R., Lemeshow S., Saulnier F. A new simplified acute physiology score (SAPS II) based on a European/North American multicenter study. The Journal of the American Medical Association. 1993; 270(24): 2957–2963. DOI: 10.1001/jama.1993.03510240069035.
  7. Fine M.J., Auble T.E., Yealy D.M., et al. A prediction rule to identify low-risk patients with community-acquired pneumonia. New England Journal of Medicine. 1997; 336(4): 243–250. DOI: 10.1056/nejm199701233360402.
  8. Vincent J.L, Moreno R., Takala J., et al. The SOFA (Sepsis-related Organ Failure Assessment) score to describe organ dysfunction/failure. Intensive Care Medicine. 1996; 22(7): 707–710. DOI: 10.1007/s001340050156.
  9. Cullen D., Civetta J., Biggs B., Ferrara L.C. Therapeutic intervention scoring system: a method for quantitative comparison of patient care. Critical Care Medicine. 1974; 2(2): 57–60. DOI: 10.1097/00003246-197403000-00001.
  10. Leteurtre S., Duhamel A., Grandbastien B., et al. Paediatric logistic organ dysfunction (PELOD) score. The Lancet. 2006; 367(9514): 897. DOI: 10.1016/s0140-6736(06)68371-2.
  11. Lim W., Van der Eerden M., Laing R., et al. Defining community acquired pneumonia severity on presentation to hospital: an international derivation and validation study. Thorax. 2003; 58(5): 377–382. DOI: 10.1136/thorax.58.5.377.
  12. Aujesky D., Auble T.E., Yealy D.M., et al. Prospective comparison of three validated prediction rules for prognosis in community-acquired pneumonia. The American Journal of Medicine. 2005; 118(4): 384–392. DOI: 10.1016/j.amjmed.2005.01.006.
  13. Seymour C.W., Liu V.X., Iwashyna T.J., et al. Assessment of clinical criteria for sepsis for the third International consensus definition for sepsis and septic shock (Sepsis-3). The Journal of the American Medical Association. 2016; 315(8): 762–774. DOI: 10.1001/jama.2016.0288.
  14. Churpek M.M., Snyder A., Han X., et al. Quick sepsis-related organ failure assessment, systemic inflammatory response syndrome, and early warning scores for detecting clinical deterioration in infected patients outside the intensive care unit. American Journal of Respiratory and Critical Care Medicine. 2017; 195(7): 906–911. DOI: 10.1164/rccm.201604–0854oc.
  15. Fernando S.M., Reardon P.M., Rochwerg B., et al. Sepsis-3 Septic Shock Criteria and Associated Mortality Among Infected Hospitalized Patients Assessed by a Rapid Response Team. Chest. 2018; 154(2): 309–316. DOI: 10.1016/j.chest.2018.05.004.
  16. Poutsiaka D.D., Porto M., Perry W., et al. Comparison of the Sepsis-2 and Sepsis-3 Definitions of Sepsis and Their Ability to Predict Mortality in a Prospective Intensive Care Unit Cohort. Open Forum Infectious Disease. 2017; 4(Suppl. 1): 602. DOI: 1093/ofid/ofx163.1579.
  17. Park H.K., Kim W.Y., Kim M.C., et al. Quick sequential organ failure assessment compared to systemic inflammatory response syndrome for predicting sepsis in emergency department. Journal of Critical Care. 2017; 42: 12–17. DOI: 10.1016/j.jcrc.2017.06.020.
  18. Battle S.E., Augustine M.R., Bookstaver P.B., et al. A Simplified Pitt Bacteremia Score (qPitt) to Predict Mortality in Patients with Gram-negative Bloodstream Infection. Open Forum Infectious Diseases. 2017; 4(S1): 555–556. DOI: 10.1093/ofid/ofx163.1445.
  19. Burnham J.P., Kollef M.H. qSOFA score: Predictive validity in Enterobacteriaceae bloodstream infections. Journal of critical care. 2018; 43: 143–147. DOI: 10.1016/j.jcrc.2017.09.011.
  20. АстафьеваМ.Н., Руднов В.А., Кулабухов В.В. и др. Использование шкалы qSOFA в прогнозе исхода у пациентов с сепсисом в ОРИТ. Результаты Российского многоцентрового исследования РИСЭС. Вестник анестезиологии и реаниматологии. 2018; 15(5): 26–35. [Astafeva M., Rudnov V., Kulabukhov V., et al. Use of the qSOFA scale in prognosis of outcome of patients with sepsis in ICU. Results of russian national study RISES. Messenger of Anesthesiology and Resuscitation. 2018; 15(5): 26–35. (In Russ)]
  21. Vincent J.L., Rello J., Marshal J., et al. International study of prevalence and outcomes of infection in ICU. The Journal of the American Medical Association. 2009; 302(21): 2323–2329. DOI: 10.1001/jama.2009.1754.
  22. Welte T., Torres A., Nathwani D. Clinical and economic burden of community-acquired pneumonia among adults in Europe. Thorax. 2012; 67(1): 71–79. DOI: 10.1136/thx.2009.129502.
  23. Chen Y.X., Wang J.W., Guo S.B. Use of CRB-65 and quick Sepsis-related Organ Failure Assessment to predict site of care and mortality in pneumonia patients in the emergency department: a retrospective study. Critical Care. 2016; 20(1): 167. DOI: 10.1186/s13054-016-1351-0.
  24. Ranzani O., Prina E., Menenez R. New Sepsis Definition (Sepsis-3) and Community-acquired Pneumonia Mortality. A Validation and Clinical Decision-Making Study. American Journal of Respiratory and Critical Care Medicine. 2017; 196(10): 1287–1297. DOI: 10.1164/rccm.201611–2262oc.
  25. Kolditz M., Scherag A., Rohde G., et al. Comparison of the qSOFA and CRB-65 for risk prediction in patients with community-acquired pneumonia. Intensive Care Medicine. 2016; 42(12): 2108–2110. DOI: 10.1007/s00134-016-4517-y.
  26. Bhattachajee P., Edelson D., Churpek M. Identifying patients with sepsis on the hospital wards. Chest. 2017; 151(4): 898–907. DOI: 10.1016/j.chest.2016.06.020.
  27. Forward E., Konecny P., Burston J., et al. Predictive validity of the qSOFA criteria for sepsis in non-ICU inpatients. Intensive Care Medicine. 2017; 43: 945–946. DOI: 10.1007/s00134-017-4776-2.
  28. Serafim R., Gomes J.A., Salluh J., Póvoa P. A comparison of the Quick-SOFA and systemic inflammatory response syndrome criteria for the diagnosis of sepsis and prediction of mortality. A systematic review and meta-anallysis. Chest. 2017; 153(3): 646–655. DOI: 10.1016/j.chest.2017.12.015.
  29. Churpek M.M., Snyder A., Sokol S., et al. Investigating the Impact of Different Suspicion of Infection Criteria on the Accuracy of Quick Sepsis-Related Organ Failure Assessment, Systemic Inflammatory Response Syndrome, and Early Warning Scores. Critical Care Medicine. 2017; 45(11): 1805–1812. DOI: 10.1097/ccm.0000000000002648.
  30. Kievlan D., Zhang L.A., Kahn J., et al. Serial evaluation of qSOFA among patients with suspected infection. Critical Care Medicine. 2016; 44(1): 412. DOI: 10.1097/01.ccm.0000510019.33158.70.
  31. Na H.J., Lee K., Jeong E.S., et al. Clinical application of the qSOFA in ICU patients with bacteremia: A single center study in Korea. Critical Care Medicine. 2016; 44(12): 410. DOI: 10.1097/01.ccm.0000510011.79792.02.
  32. Nishiwaki H., Hasegawa T., Sasaki S., et al. External validation study of the qSOFA for Japanese patients undergoing hemodialysis. Nephrology Dialysis Transplantation. 2017; 32(Suppl. 3): 482. DOI: 10.1093/ndt/gfx164.mp148.
  33. АстафьеваМ.Н., Руднов В.А., Кулабухов В.В. и др. Использование шкалы qSOFA в диагностике сепсиса. Вестник анестезиологии и реаниматологии. 2018; 15(4): 14–22. [Astafeva M., Rudnov V., Kulabukhov V., et al. Use of the qSOFA scale in diagnosis of sepsis. Results of russian national study RISES. Messenger of Anesthesiology and Resuscitation. 2018; 15(4): 14–22. (In Russ)]
  34. Kyo M., Ohshimo S., Kida Y., Shime N. The validation qSOFA criteria for sepsis. Critical Care Medicine. 2016; 44(12): 448. DOI: 10.1097/01.ccm.0000510166.80446.5f.
  35. Holdstock V., Shaw M., Puxty A., et al. Ability of qSOFA, SIRS, NEWS, SOFA predict sepsis in patients admitted to ICU. Critical Care Medicine. 2018; 46(1): 740. DOI: 10.1097/01.ccm.0000529515.19526.73.
  36. Schlapbach L.J., Straney L., Bellomo R., et al. Prognostic accurancy of age-adapted SOFA, SIRS, PELOD-2 and qSOFA for in-hospital mortality among children with suspected infection admitted to the intensive care unit. Intensive Care Medicine. 2018; 44(2): 179–188. DOI: 10.1007/s00134-017-5021-8.
  37. Sprung C., Schein R., Balk R. The new consensus definitions: the good, the bad and the ugly. Intensive Care Medicine 2016; 42(12): 2024–2026. DOI: 10.1007/s00134-016-4604-0.
  38. Fantom N., Serajuddin U. The World Bankʼs Classification of Countries by Income, Policy Research Working Paper Series, no. 7528, Washington, DC: World Bank. 2016. [Internet] Available from (accessed 01.07.2018).
  39. Mills A. Health Care systems in low- and middle-income countries. New England Journal of Medicine. 2014; 370(6): 552–557. DOI: 10.1056/nejmra1110897.
  40. Rudd K.E., Seymour C.W., Aluisio A.R., et al. Association of the Quick Sequential (Sepsis-Related) Organ Failure Assessment (qSOFA) Score With Excess Hospital Mortality in Adults With Suspected Infection in Low- and Middle-Income Countries. The Journal of the American Medical Association. 2018; 319(21): 2202–2211. DOI: 10.1001/jama.2018.6229.
  41. Khwannimit B., Bhurayanontachai R., Vattanavanit V. Comparison of the performance of SOFA, qSOFA and SIRS for predicting mortality and organ failure among sepsis patients admitted to the intensive care unit in a middle-income country. Journal of Critical Care. 2018; 44: 156–160. DOI: 10.1016/j.jcrc.2017.10.023.
  42. Ho K.M., Lan N.S.H. Combining quick Sequential Organ Failure Assessment with plasma lactate concentration is comparable to standard Sequential Organ Failure Assessment score in predicting mortality of patients with and without suspected infection. Journal of Critical Care. 2017; 38: 1–5. DOI: 10.1016/j.jcrc.2016.10.005.
  43. Jung Y.T., Lee J.G., Lee S.H., et al. Combination of QSOFA score with hyperlactatemia improves mortality prediction for surgical patients. Critical Care Medicine. 2018; 46(1): 715. DOI: 10.1097/01.ccm.0000529464.06958.86.
  44. Song J.U., Sin C.K., Park H.K., et al. Performance of the quick Sequential (sepsis-related) Organ Failure Assessment score as a prognostic tool in infected patients outside the intensive care unit: a systematic review and meta-analysis. Critical Care. 2018; 22(1): 28. DOI: 10.1186/s13054-018-1952-x.
  45. Maitra S., Som A., Bhattacharjee S. Accuracy of quick Sequential Organ Failure Assessment (qSOFA) score and systemic inflammatory response syndrome (SIRS) criteria for predicting mortality in hospitalized patients with suspected infection: A meta-analysis of observational studies. Clinical Microbiology and Infection. 2018; 24(11): 1123–1129. DOI: 10.1016/j.cmi.2018.03.032.
  46. Barreto B., Luz M., Gusmao-Flores D. Prognostic accurancy of quick sequential organ failure assessment (qSOFA) score for mortality: systematic review and meta-analysis. Critical Care. 2018; 22(S1): 34. DOI: 10.1186/s13054-018-1973-5.
  47. Fernando S.M., Tran A., Taljaard M., et al. Prognostic accuracy of the quick sequential organ failure assessment for mortality in patients with suspected infection. Annals of Internal Medicine. 2018; 168(4): 266–275. DOI:10.7326/M17–2820.

Continuous Monitoring of Venous Lactate and Glucose Using Intravascular Microdialysis During Perioperative Period in High-risk Cardiac Surgery

P.I. Lenkin1, 2, A.A. Ushakov1, M.Y. Kirov1, 2

1Department of Anesthesiology and Intensive Care Medicine, Northern State Medical University, Arkhangelsk

2Department of Anesthesiology and Intensive Care Medicine, City Hospital 1 of Arkhangelsk

For correspondence: Lenkin Pavel I. — Department of Anesthesiology and Intensive Care Medicine, Northern State Medical University, Arkhangelsk; e-mail:

For citation: Lenkin PI, Ushakov AA, Kirov MY. Continuous Monitoring of Venous Lactate and Glucose Using Intravascular Microdialysis During Perioperative Period in High-risk Cardiac Surgery. Intensive Care Herald. 2016;4:72–77.

We present two clinical cases of the successful application of a novel technique for continuous lactate and glucose monitoring using intravascular microdialysis during perioperative period in high-risk cardiac surgery.

Keywords: lactate, intravascular microdialysis, monitoring, cardiac surgery

Received: 06.12.2016


  1. Pretre R., Turina M.I. Valve diseases: Cardiac valve surgery in octogenarian. Heart. 2000; 83: 116–21. doi: 10.1136/heart.83.1.116.
  2. Hirai S. Systemic inflammatory response syndrome after cardiac surgery under cardiopulmonary bypass. Thorac. Cardiovasc. Surg. 2003; 9: 365–370.
  3. Holmes J.H., Connolly N.C., Paull D.L. et al. Magnitude of the inflammatory response to cardiopulmonary bypass and its relation to adverse clinical outcomes. Inflamm. Res. 2002; 51: 579–586. doi: 10.1007/PL00012432.
  4. Goepfert M.S., Reuter D.A., Akyol D. et al. Goal-directed fluid management reduces vasopressor and catecholamine use in cardiac surgery patients. Care Med. 2007; 33: 96–103.
  5. Goepfert M.S., Richter H.P., Zu Eulenburg C. et al. Individually optimized hemodynamic therapy reduces complications and length of stay in the intensive care unit: a prospective, randomized controlled trial. Anesthesiology. 2013; 119: 824–836. doi: 10.1097/ALN.0b013e31829bd770.
  6. Lenkin A.I., Kirov M.Y., Kuzkov V.V. et al. Comparison of goal-directed hemodynamic optimization using pulmonary artery catheter and transpulmonary thermodilution in combined valve repair: a randomized clinical trial. Care Res. Pract. 2012; article ID 821218. doi: 10.1155/2012/821218.
  7. Bakker J., Nijsten M.W.N., Jansen T.C. Clinical use of lactate monitoring in critically ill patients. Ann. Intens. Care. 2013; 3: 12. doi: 10.1186/2110-5820-3-12.
  8. Schierenbeck F., Nijsten M.W.N., Franco-Cereceda A. et al. Introducing intravascular microdialysis for continuous lactate monitoring in patients undergoing cardiac surgery: a prospective observational study. Care. 2014; 18: 56. doi: 10.1186/cc13808.
  9. Schierenbeck F., Nijsten M.W.N., Franco-Cereceda A. et al. Evaluation of a continuous blood glucose monitoring system using central venous microdialysis. J. Diabetes. Sci. Tehnol. 2012; 6: 1366–1371. doi: 10.1177/193229681200600615.
  10. Lenkin P.I., Smetkin A.A., Hussain A. et al. Continuous monitoring of lactate using intravascular microdialysis in high-risk cardiac surgery: a prospective observational study. J. Cardiothorac. Vasc. Anesth. 2016. doi:
  11. O’Connor E.D., Fraser J.F. Hyperlactatemia in critical illness and cardiacsurgery. Crit. Care. 2010; 14: 421. doi: 10.1186/cc9017.
  12. Ranucci M., De Tofol B., Isgro G. et al. Hyperlactatemia during cardiopulmonary bypass: determinants and impact on postoperative outcome. Crit. Care. 2006; 10(6): R167.
  13. Maillet J.M., Le Besnerais P., Cantoni M. et al. Frequency, risk factors, and outcome of hyperlactatemia after cardiac surgery. Chest. 2003; 123: 1361–1366. doi:
  14. Joudi M., Fathi M., Soltani G. et al. Factors affecting on serum lactate after cardiac surgery. Anesth. Pain Med. 2014; 4: e18514. doi: 10.5812/aapm.18514.
  15. Nguyen H.B., Rivers E.P., Knoblich B.P. et al. Early lactate clearance is associated with improved outcome in severe sepsis and septic shock. Care Med. 2004; 32: 1637–1642. doi: 10.1097/01.CCM.0000132904.35713.A7.
  16. Hernandez G., Regueira T., Bruhn A. et al. Relationship of systemic, hepatosplanchnic, and microcirculatory perfusion parameters with 6-hour lactate clearance in hyperdynamic septic shock patients: an acute, clinical-physiological, pilot study. Annals of Intensive Care. 2012; 2: 44. doi: 10.1186/2110-5820-2-44.
  17. Van den Berghe G. How does blood glucose control with insulin save lives in intensive care? Clin. Invest. 2004; 114(9): 1187–1195. doi: 10.1172/JCI23506.
  18. Gandhi G.Y., Nuttall G.A., Abel M.D. et al. Intra-operative hyperglycemia and perioperative outcomes in cardiac surgery patients. Clin. Proc. 2005; 80: 862–866.
  19. Kalmovich B., Bar-Dayan Y., Boaz M., Wainstein J. Continuous glucose monitoring in patients undergoing cardiac surgery. Diabetes technology & therapeutics. 2012; 14(3): 232–238. doi: 10.1089/dia.2011.0154.
  20. Critchell C.D., Savarese V., Callahan A. et al. Accuracy of bedside capillary blood glucose measurements in critically ill patients. Care Med. 2007; 33: 2079–2084. doi: 10.1007/s00134-007-0835-4.
  21. Krinsley J.S. Glycemic variability: a strong independent predictor of mortality in critically ill patients. Crit. Care Med. 2008; 36(11): 3008–3013. doi: 10.1097/CCM.0b013e31818b38d2.
  22. Mechanick J.I., Handelsman Y., Bloomgarden Z.T. Hypoglycemia in the intensive care unit. Opin. Clin. Nutr. Metab. Care. 2007; 10(2): 193–196. doi: 10.1097/MCO.0b013e32802b7016.

Remaxol dose-dependent effect on central hemodynamics and metabolism in generalized peritonitis

Yu.P. Orlov, V.N. Lukacs, N.V. Govorova, A.V. Glushchenko, O.D. Dmitrieva

GBOY VPO “Omsk State Medical University” Ministry of Health of Russia, Omsk

For citation: Orlov YuP, Lukach VN, Govorova NV et al. Remaxol dose-dependent effect on central hemodynamics and metabolism in generalized peritonitis. Intensive Care Herald. 2016;1:27–32.

The aim of the study was to investigate the effectiveness of inclusion in remaxol regimens on hemodynamic parameters and processes of cellular metabolism in patients with severe generalized peritonitis.

Results of treatment of 24 patients who received preoperative medication preparation and surgical treatment in accordance with the standards of conduct, in the postoperative period 2 groups with the same intensive treatment protocol were formed. Patients of the first group (n=12) were administered for 5 days remaxol 800 ml per day. The second group (control) (n=12) in the program which remaxol infusion therapy was not used.

Results of the study showed that the inclusion of infusion therapy remaxol scheme in the postoperative period in patients with generalized peritonitis ensures efficient utilization of glucose and oxygen, reduces the severity of oxygen debt at the tissue level, providing mechanisms of oxidation on the more familiar processes for fabrics way, providing at the same time kateholaminomimetichesky effect, providing an earlier period when the central and stabilization of hemodynamic parameters during its injection velocity of 30 to 60 ml per hour.

Keywords: generalized peritonitis, remaxol, infusion therapy, lactate.


  1. Shapiro N., Howell M.D., Bates D.W, et al. The association of sepsis syndrome and organ dysfunction with mortality in emergency department patients with suspected infection. Ann Emerg Med. 2006; 48(5): 583-590.
  2. Kleinpell R.M., Graves B.T, Ackerman M.H. Incidence, pathogenesis, and management of sepsis: an overview. AACN Adv Crit Care. 2006; 17(4): 385-
  3. Whelan S.P., Carchman E.H, Kautza B., Nassour I. et al. Polymicrobial sepsis is associated with decreased hepatic oxidative phosphorylation and an altered metabolic profile. J Surg Res. 2014 Jan; 186 (1): 297-303.
  4. Zang Q.S., Wolf S.E., Minei J.P. Sepsis-induced Cardiac Mitochondrial Damage and Potential Therapeutic Interventions in the Elderly. Aging Dis. 2014 Apr 1; 5 (2): 137-149.
  5. Calandra T., Cohen J. The international sepsis forum consensus conference on definitions of infection in the intensive care unit. Crit Care Med 2005; 33, (7): 1538-1548.
  6. Sims C.A., Wattanasirichaigoon S., Menconi M.J., Ajami A.M., Fink M.P. Ringer’s ethyl pyruvate solution ameliorates ischemia/reperfusion-induced intestinal mucosa injury in rats. Crit Care Med. 2001; 29 (8): 1513-
  7. Tawadrous Z.S., Delude R.L., Fink M.P. Resuscitation from hemorrhagic shock with Ringer’s ethyl pyruvate solution improves survival and ameliorates intestinal mucosal hyperpermeability in rats. Shock. 2002; 17 (6):473-
  8. Guo J., Zhang J., Luo X., et al. Effects of ethyl pyruvate on cardiac function recovery and apoptosis reduction after global cold ischemia and reperfusion. Exp Ther Med. 2014; 7(5): 1197-
  9. Hu X., Cui B., Zhou X., et al. Ethyl pyruvate reduces myocardial ischemia and reperfusion injury by inhibiting high mobility group box 1 protein in rats. Mol Biol Rep. 2012; 39 (1): 227-
  10. Руднов В.А., Миронов П.И. Клинические рекомендации по ведению больных с тяжелым сепсисом и септическим шоком (Surviving sepsis campaign 2008): анализ и комментарии. Клин микробиол антимикроб химиотер 2008.- т.10, №3.-192-200.