The influence of early hemodynamic optimization on biomarker patterns of severe sepsis and septic shock
The influence of early hemodynamic optimization on biomarker patterns of severe sepsis and septic shock
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DOI：
10.1097/01.ccm.0000281637.08984.6e
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发表时间：
2007-09-01
影响因子：
8.8
通讯作者：
Childs, Ed W.
中科院分区：
文献类型：
--
作者：
Rivers, Emanuel P.;Kruse, James A.;Childs, Ed W.
背景尽管对早期严重脓毒症和脓毒性休克的生物标志物模式进行了大量的实验研究，但人类数据很少。此外，复苏策略导致的整体组织缺氧的严重程度对这些早期生物标志物模式的影响仍然未知。白细胞介素-1受体拮抗剂、细胞间粘附分子-1、肿瘤坏死因子-α、半胱天冬酶-3、和白细胞介素-8在早期血流动力学优化策略的早期目标-严重脓毒症和脓毒性休克患者的定向治疗与标准治疗。这些生物标志物模式的关系，每个血流动力学优化策略，全球组织缺氧的严重程度（反映乳酸和中心静脉血氧饱和度），器官功能障碍，和mortality进行了examined.Results：异常的生物标志物水平存在于医院介绍和调制不同的模式在3小时内的血流动力学优化策略的基础上。这些模式的时间表达超过72小时，与全球组织缺氧，器官功能障碍，和mortality.Conclusion的严重程度显着相关：在早期严重脓毒症和感染性休克，在第一个3小时的医院介绍，不同的生物标志物模式出现在响应血流动力学优化策略。前72小时的时间生物标志物模式、整体组织缺氧的严重程度、器官功能障碍和死亡率之间存在显著关联。这些发现确定了整体组织缺氧是早期炎症反应的重要因素，并支持血流动力学优化在诊断和治疗“机会窗口”期间补充其他既定疗法的作用。"
Background. Despite abundant experimental studies of biomarker patterns in early severe sepsis and septic shock, human data are few. Further, the impact of the severity of global tissue hypoxia resulting from resuscitative strategies on these early biomarker patterns remains unknown.Methods: The temporal patterns of interleukin-1 receptor antagonist, intercellular adhesion molecule-1, tumor necrosis factor-alpha, caspase-3, and interleukin-8 were serially examined over the first 72 hrs of hospitalization after early hemodynamic optimization strategies of early goal-directed vs. standard therapy for severe sepsis and septic shock patients. The relationship of these biomarker patterns to each hemodynamic optimization strategy, severity of global tissue hypoxia (reflected by lactate and central venous oxygen saturation), organ dysfunction, and mortality were examined.Results: Abnormal biomarker levels were present upon hospital presentation and modulated to distinct patterns within 3 hrs based on the hemodynamic optimization strategy. The temporal expression of these patterns over 72 hrs was significantly associated with the severity of global tissue hypoxia, organ dysfunction, and mortality.Conclusion: In early severe sepsis and septic shock, within the first 3 hrs of hospital presentation, distinct biomarker patterns emerge in response to hemodynamic optimization strategies. A significant association exists between temporal biomarker patterns in the first 72 hrs, severity of global tissue hypoxia, organ dysfunction, and mortality. These findings identify global tissue hypoxia as an important contributor to the early inflammatory response and support the role of hemodynamic optimization in supplementing other established therapies during this diagnostic and therapeutic "window of opportunity."