Impaired vascular reactivity in sepsis - a systematic review with meta-analysis.
Impaired vascular reactivity in sepsis - a systematic review with meta-analysis.
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DOI：
10.5114/amsad.2019.86754
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发表时间：
2019-01-01
期刊：
影响因子：
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通讯作者：
Vanags, Indulis
中科院分区：
文献类型：
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作者：
Kazune, Sigita;Piebalga, Anda;Vanags, Indulis
引言：一氧化氮生物利用度降低导致的血管功能障碍在脓毒症的发病机制中起着重要作用。本荟萃分析研究证据从已发表的文献，以评估是否在成人人群中的存在/严重程度的脓毒症与受损vasreactivity.MATERIAL和METHODS：我们进行了搜索的Medline，Scopus，和EMBASE数据库，以确定观察性研究使用测量反应性充血在成人患者脓毒症。在使用预定义的方案提取数据后，对结果进行定性合成，以确定方法之间结果的一致性、血管反应性与脓毒症严重程度、多器官衰竭和死亡之间的相关性证据。一个荟萃分析的标准化的平均差异，在血管反应性组之间进行，其中数据可用于相关outcome.RESULTS：十八项研究，使用四种方法来衡量血管反应性，共466被列入分析。合并的标准化平均差异估计值显示，脓毒症患者的反应性充血少于对照组（-2.59，95%CI：-3.46至-1.72; p < 0.00001），脓毒症患者的峰值充血血流量低于对照组（SMD =-1.42，95% CI：-2.14至-0.70; p = 0.0001）。非幸存者和幸存者之间的反应性充血的合并SMD为-0.36（95%CI：-0.67至-0.06; p = 0.02），峰值充血血流为-0.70（95%CI：-1.13至-0.27; p = 0.001）。结论：与健康志愿者相比，脓毒症患者的血管反应性减弱。没有足够的数据表明这些变化可以识别器官衰竭恶化或死亡风险的患者。
INTRODUCTION: Vascular dysfunction due to reduced nitric oxide bioavailability plays an important role in the pathogenesis of sepsis. This meta-analysis examines evidence from published literature to evaluate whether in the adult population the presence/severity of sepsis is associated with impaired vasoreactivity.MATERIAL AND METHODS: We performed a search of the Medline, Scopus, and EMBASE databases to identify observational studies using measurement of reactive hyperaemia in adult patients with sepsis. After data extraction using predefined protocol, qualitative synthesis of findings was performed regarding consistency of findings between methods, evidence of association between vascular reactivity and severity of sepsis, multiple organ failure, and death. A meta-analyses of standardised mean differences in vasoreactivity between groups was performed, in which data were available for relevant outcomes.RESULTS: Eighteen studies using four methods to measure vascular reactivity from a total of 466 were included in the analysis. The pooled standardised mean difference estimate showed that septic patients had less reactive hyperaemia than controls (-2.59, 95% CI: -3.46 to -1.72; p < 0.00001), and peak hyperaemic blood flow was lower in patients with sepsis than in the control group (SMD = -1.42, 95% CI: -2.14 to -0.70; p = 0.0001). The combined SMD between non survivors and survivors was -0.36 (95% CI: -0.67 to -0.06; p = 0.02) for reactive hyperaemia and -0.70 (95% CI: -1.13 to -0.27; p = 0.001) for peak hyperaemic blood flow.CONCLUSIONS: Septic patients have attenuated vascular reactivity when compared to healthy volunteers. There are insufficient data indicating that these changes can identify patients at risk of worsening organ failure or death.