The purpose of this study was to determine if once-daily arterial pressure measurements are a reliable estimate of actual time-averaged arterial pressure in neurogenic hypertensive rats. Male rats were subjected to either aortic baroreceptor deafferentation (ABD, n = 10) or sham operation (SO, n = 10). One to 3 mo later, arterial pressure (AP) was recorded from a chronic indwelling catheter in each rat for 72 continuous hours. Subsequently, AP was determined once a day (10- to 30-min recording periods) in each rat for an additional 3 consecutive days. Continuous recording yielded an average mean arterial pressure (MAP) of 104 +/- 2 mmHg in SO rats and an average mean MAP of 120 +/- 3 mmHg in ABD rats. Standard deviation of MAP measured every 5 min for 24 consecutive hours (as an index of pressure lability) was 8.0 +/- 0.4 mmHg in SO rats and 14.4 +/- 1.3 mmHg in ABD rats. Both of the above differences were statistically significant (P less than 0.05). The average MAP from daily measurements in the same rats was 107 +/- 3 mmHg in SO rats and 124 +/- 3 mmHg in ABD rats. Average pressure values were not statistically different for the two measurement techniques in either group of rats. Overall, there existed a significant correlation (r = 0.64, P less than 0.01) between MAP measured continuously and daily in the 20 rats studied. We conclude that daily direct measurement of MAP in conscious ABD rats yields a satisfactory estimate of actual time-averaged MAP in these rats despite their markedly increased MAP lability.
ObjectivesThe acute respiratory distress syndrome (ARDS) is a heterogeneous condition, and identification of subphenotypes may help in better risk stratification. Our study objective is to identify ARDS subphenotypes using new simpler methodology and readily available clinical variables.SettingThis is a retrospective Cohort Study of ARDS trials. Data from the US ARDSNet trials and from the international ART trial.Participants3763 patients from ARDSNet data sets and 1010 patients from the ART data set.Primary and secondary outcome measuresThe primary outcome was 60-day or 28-day mortality, depending on what was reported in the original trial. K-means cluster analysis was performed to identify subgroups. Sets of candidate variables were tested to assess their ability to produce different probabilities for mortality in each cluster. Clusters were compared with biomarker data, allowing identification of subphenotypes.ResultsData from 4773 patients were analysed. Two subphenotypes (A and B) resulted in optimal separation in the final model, which included nine routinely collected clinical variables, namely heart rate, mean arterial pressure, respiratory rate, bilirubin, bicarbonate, creatinine, PaO2, arterial pH and FiO2. Participants in subphenotype B showed increased levels of proinflammatory markers, had consistently higher mortality, lower number of ventilator-free days at day 28 and longer duration of ventilation compared with patients in the subphenotype A.ConclusionsRoutinely available clinical data can successfully identify two distinct subphenotypes in adult ARDS patients. This work may facilitate implementation of precision therapy in ARDS clinical trials.
Purpose:Among patients with vasodilatory shock, gene expression scores may identify different immune states. We aimed to test whether such scores are robust in identifying patients’ immune state and predicting response to hydrocortisone treatment in vasodilatory shock.Materials and Methods:We selected genes to generate continuous scores to define previously established subclasses of sepsis. We used these scores to identify a patient's immune state. We evaluated the potential for these states to assess the differential effect of hydrocortisone in two randomized clinical trials of hydrocortisone versus placebo in vasodilatory shock.Results:We initially identified genes associated with immune-adaptive, immune-innate, immune-coagulant functions. From these genes, 15 were most relevant to generate expression scores related to each of the functions. These scores were used to identify patients as immune-adaptive prevalent (IA-P) and immune-innate prevalent (IN-P). In IA-P patients, hydrocortisone therapy increased 28-day mortality in both trials (43.3% vs 14.7%, P = 0.028) and (57.1% vs 0.0%, P = 0.99). In IN-P patients, this effect was numerically reversed.Conclusions:Gene expression scores identified the immune state of vasodilatory shock patients, one of which (IA-P) identified those who may be harmed by hydrocortisone. Gene expression scores may help advance the field of personalized medicine.
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