Plasma Nitric Oxide Consumption Is Elevated and Associated With Adverse Outcomes in Critically Ill Patients.
Plasma Nitric Oxide Consumption Is Elevated and Associated With Adverse Outcomes in Critically Ill Patients.
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DOI：
10.1097/ccm.0000000000006006
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发表时间：
2023-12-01
影响因子：
8.8
通讯作者：
中科院分区：
文献类型：
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作者：
一氧化氮（NO）生物利用度受损可能导致败血症微血管功能障碍。过量的血浆NO消耗归因于循环无细胞血红蛋白的清除。这可能是脓毒症和危重症中NO缺乏的机制。我们假设危重患者，特别是脓毒症、急性呼吸窘迫综合征（ARDS）、休克和住院非幸存者的血浆NO消耗高。我们进一步假设血浆NO消耗与血浆无细胞血红蛋白浓度相关。回顾性队列研究。学术医疗中心的成人icu。重症患者362例，健康对照46例。没有。用还原性化学发光法测定血浆NO消耗，用比色法测定无细胞血红蛋白。危重患者的平均（95% CI）血浆NO消耗（µM）高于健康对照组（3.9 [3.7 - 4.1]vs 2.1[1.8-2.5]），脓毒症患者vs非脓毒症患者（4.1 [3.8-4.3]vs 3.6 [3.3-3.8]）， ARDS vs非ARDS患者（4.4 [4.0-4.9]vs 3.7[3.6 - 3.9]），休克vs非休克患者（4.4 [4.0-4.8]vs 3.6[3.4-3.8]），医院非幸存者vs幸存者（5.3 [4.4 - 6.4]vs 3.7[3.6 - 3.9]）。这些关系在多变量分析中仍然显著。血浆无细胞血红蛋白与血浆NO消耗呈弱相关。危重患者血浆NO消耗升高，与败血症、ARDS、休克和院内死亡独立相关。这些数据表明，过度的血管内NO清除是脓毒症和危重疾病不良结局的特征。
Impaired nitric oxide (NO) bioavailability may contribute to microvascular dysfunction in sepsis. Excessive plasma NO consumption has been attributed to scavenging by circulating cell-free hemoglobin. This may be a mechanism for NO deficiency in sepsis and critical illness. We hypothesized that plasma NO consumption is high in critically ill patients, particularly those with sepsis, acute respiratory distress syndrome (ARDS), shock, and in hospital nonsurvivors. We further hypothesized that plasma NO consumption is correlated with plasma cell-free hemoglobin concentration. Retrospective cohort study. Adult ICUs of an academic medical center. Three hundred sixty-two critically ill patients and 46 healthy control subjects. None. Plasma NO consumption was measured using reductive chemiluminescence and cell-free hemoglobin was measured with a colorimetric assay. Mean (95% CI) plasma NO consumption (µM) was higher in critically ill patients versus healthy control subjects (3.9 [3.7–4.1] vs 2.1 [1.8–2.5]), septic versus nonseptic patients (4.1 [3.8–4.3] vs 3.6 [3.3–3.8]), ARDS versus non-ARDS patients (4.4 [4.0–4.9] vs 3.7 [3.6–3.9]), shock vs nonshock patients (4.4 [4.0–4.8] vs 3.6 [3.4–3.8]), and hospital nonsurvivors versus survivors (5.3 [4.4–6.4] vs 3.7 [3.6–3.9]). These relationships remained significant in multivariable analyses. Plasma cell-free hemoglobin was weakly correlated with plasma NO consumption. Plasma NO consumption is elevated in critically ill patients and independently associated with sepsis, ARDS, shock, and hospital death. These data suggest that excessive intravascular NO scavenging characterizes sepsis and adverse outcomes of critical illness.
影响因子：
11.4
作者：
Oh, Joo-Yeun;Hamm, Jennifer;Xu, Xin;Genschmer, Kristopher;Zhong, Ming;Lebensburger, Jeffrey;Marques, Marisa B.;Kerby, Jeffrey D.;Pittet, Jean-Francois;Gaggar, Amit;Patel, Rakesh P.
通讯作者：
Patel, Rakesh P.
根据抗氧化剂维生素的摄入，重症患者的氧化应激增加，与严重程度无关：一项队列研究。
影响因子：
15.1
作者：
Abiles, Jimena;de la Cruz, Antonio Perez;Castano, Jose;Rodriguez-Elvira, Manuel;Aguayo, Eduardo;Moreno-Torres, Rosario;Llopis, Juan;Aranda, Pilar;Argueelles, Sandro;Ayala, Antonio;de la Quintana, Alberto Machado;Planells, Elena Maria
通讯作者：
Planells, Elena Maria