Severe abnormalities in microvascular perfused vessel density are associated to organ dysfunctions and mortality and can be predicted by hyperlactatemia and norepinephrine requirements in septic shock patients.
Severe abnormalities in microvascular perfused vessel density are associated to organ dysfunctions and mortality and can be predicted by hyperlactatemia and norepinephrine requirements in septic shock patients.
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DOI：
10.1016/j.jcrc.2012.11.022
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发表时间：
2013-08-01
影响因子：
3.7
通讯作者：
Ince, Can
中科院分区：
文献类型：
--
作者：
Hernandez, Glenn;Boerma, E Christiaan;Ince, Can
目得：本研究的目的是确定灌注血管密度（PVD）与死亡率和器官功能障碍的一般关系，并探讨该参数分布最低四分位数的患者是否存在更高的不良结局风险，并确定全身血流动力学和灌注变量，以提高发现严重潜在微血管功能障碍的概率。材料和方法：这是一项回顾性多中心研究，包括122名感染性休克患者，参与7项前瞻性临床试验，在早期复苏期间至少进行1次舌下微循环评估。灌注血管密度与器官功能障碍和死亡率显著相关，但这种效应主要是由PVD分布最低四分位数的患者解释的（死亡率P = 0.037 [优势比（OR），8.7; 95%置信区间（CI），1.14-66.78]）。高乳酸（P <0.026 [OR，1.23; 95% CI，1.03-1.47]）和高去甲肾上腺素需求（P <0.019 [OR，7.04; 95% CI，1.38-35.89]）增加了发现严重微血管功能障碍的几率。灌注血管密度与感染性休克患者的器官功能障碍和死亡率显著相关，特别是在表现出由该参数的最低四分位分布所表示的更严重异常的患者中。高乳酸血症和高去甲肾上腺素需求的存在增加了舌下微循环评估期间发现严重潜在微血管功能障碍的几率。
PURPOSE: The aims of this study are to determine the general relationship of perfused vessel density (PVD) to mortality and organ dysfunctions and to explore if patients in the lowest quartile of distribution for this parameter present a higher risk of bad outcome and to identify systemic hemodynamic and perfusion variables that enhances the probability of finding a severe underlying microvascular dysfunction.MATERIALS AND METHODS: This is a retrospective multicenter study including 122 septic shock patients participating in 7 prospective clinical trials on which at least 1 sublingual microcirculatory assessment was performed during early resuscitation.RESULTS: Perfused vessel density was significantly related to organ dysfunctions and mortality, but this effect was largely explained by patients in the lowest quartile of distribution for PVD (P = .037 [odds ratio {OR}, 8.7; 95% confidence interval {CI}, 1.14-66.78] for mortality). Hyperlactatemia (P < .026 [OR, 1.23; 95% CI, 1.03-1.47]) and high norepinephrine requirements (P < .019 [OR, 7.04; 95% CI, 1.38-35.89]) increased the odds of finding a severe microvascular dysfunction.CONCLUSIONS: Perfused vessel density is significantly related to organ dysfunctions and mortality in septic shock patients, particularly in patients exhibiting more severe abnormalities as represented by the lowest quartile of distribution for this parameter. The presence of hyperlactatemia and high norepinephrine requirements increases the odds of finding a severe underlying microvascular dysfunction during a sublingual microcirculatory assessment.