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Sepsis-associated microvascular dysfunction measured by peripheral arterial tonometry: an observational study

机译：脓毒症相关的微血管功能障碍通过外周动脉眼压计测量：一项观察性研究

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IntroductionSepsis has a high mortality despite advances in management. Microcirculatory and endothelial dysfunction contribute to organ failure, and better tools are needed to assess microcirculatory responses to adjunctive therapies. We hypothesised that peripheral arterial tonometry (PAT), a novel user-independent measure of endothelium-dependent microvascular reactivity, would be impaired in proportion to sepsis severity and related to endothelial activation and plasma arginine concentrations.MethodsObservational cohort study in a 350-bed teaching hospital in tropical Australia. Bedside microvascular reactivity was measured in 85 adults with sepsis and 45 controls at baseline and 2-4 days later by peripheral arterial tonometry. Microvascular reactivity was related to measures of disease severity, plasma concentrations of L-arginine (the substrate for nitric oxide synthase), and biomarkers of endothelial activation.ResultsBaseline reactive hyperaemia index (RH-PAT index), measuring endothelium-dependent microvascular reactivity; (mean [95% CI]) was lowest in severe sepsis (1.57 [1.43-1.70]), intermediate in sepsis without organ failure (1.85 [1.67-2.03]) and highest in controls (2.05 [1.91-2.19]); P < 0.00001. Independent predictors of baseline RH-PAT index in sepsis were APACHE II score and mean arterial pressure, but not plasma L-arginine or markers of endothelial activation. Low baseline RH-PAT index was significantly correlated with an increase in SOFA score over the first 2-4 days (r = -0.37, P = 0.02).ConclusionsEndothelium-dependent microvascular reactivity is impaired in proportion to sepsis severity and suggests decreased endothelial nitric oxide bioavailability in sepsis. Peripheral arterial tonometry may have a role as a user-independent method of monitoring responses to novel adjunctive therapies targeting endothelial dysfunction in sepsis.
机译：引言尽管管理有进步，脓毒症的死亡率仍然很高。微循环和内皮功能障碍会导致器官衰竭，因此需要更好的工具来评估对辅助疗法的微循环反应。我们假设外周动脉眼压（PAT）是一种新型的，独立于用户的内皮依赖性微血管反应性测量方法，与脓毒症的严重程度成正比，并且与内皮活化和血浆精氨酸浓度有关，因此会受到损害。热带澳大利亚医院。在基线和2-4天后，通过外周动脉眼压计测量了85名患有败血症的成年人和45名对照的床旁微血管反应性。微血管反应性与疾病严重程度，L-精氨酸（一氧化氮合酶的底物）的血浆浓度以及内皮细胞活化的生物标志物的测定有关。结果基线反应性充血指数（RH-PAT指数），用于测量内皮依赖性微血管反应性; （平均[95％CI]）在严重脓毒症中最低（1.57 [1.43-1.70]），在没有器官衰竭的脓毒症中最低（1.85 [1.67-2.03]），在对照组中最高（2.05 [1.91-2.19]）; P ＜0.00001。脓毒症中基线RH-PAT指数的独立预测因子是APACHE II评分和平均动脉压，但不是血浆L-精氨酸或内皮细胞激活标记物。基线RH-PAT指数低与头2-4天的SOFA评分升高显着相关（r = -0.37，P = 0.02）。结论败血症的严重程度与内皮依赖性微血管反应性降低有关，提示内皮型一氧化氮降低败血症中氧化物的生物利用度。外周动脉眼压测量法可能是一种独立于用户的方法，用于监测针对脓毒症中内皮功能障碍的新型辅助疗法的反应。

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