Use of reactive hyperemia - peripheral arterial tonometry and circulating biological markers to predict outcomes in sepsis

Abstract

ObjectiveTo evaluate the usefulness and prognostic value of reactive hyperemia - peripheral arterial tonometry in patients with sepsis. Moreover, we investigated the association of reactive hyperemia - peripheral arterial tonometry results with serum levels of certain inflammatory molecules.MethodsProspective study, conducted in an 18-bed mixed intensive care unit for adults. The exclusion criteria included severe immunosuppression or antibiotic therapy initiated more than 48 hours before assessment. We measured the reactive hyperemia - peripheral arterial tonometry on inclusion (day 1) and on day 3. Interleukin-6, interleukin-10, high-mobility group box 1 protein and soluble ST2 levels were measured in the blood obtained upon inclusion.ResultsSeventeen of the 79 patients (21.6%) enrolled were determined to have reactive hyperemia - peripheral arterial tonometry signals considered technically unreliable and were excluded from the study. Thus, 62 patients were included in the final analysis, and they underwent a total of 95 reactive hyperemia - peripheral arterial tonometry exams within the first 48 hours after inclusion. The mean age was 51.5 (SD: 18.9), and 49 (62%) of the patients were male. Reactive hyperemia indexes from days 1 and 3 were not associated with vasopressor need, Sequential Organ Failure Assessment score, Acute Physiology and Chronic Health Evaluation II score, or 28-day mortality. Among the patients who died, compared with survivors, there was a significant increase in the day 3 reactive hyperemia index compared with day 1 (p = 0.045). There was a weak negative correlation between the day 1 reactive hyperemia - peripheral arterial tonometry index and the levels of high-mobility group box 1 protein (r = -0.287).ConclusionTechnical difficulties and the lack of clear associations between the exam results and clinical severity or outcomes strongly limits the utility of reactive hyperemia - peripheral arterial tonometry in septic patients admitted to the intensive care unit.

Peripheral arterial tonometry as a method of measuring reactive hyperaemia correlates with organ dysfunction and prognosis in the critically ill patient: a prospective observational study

“…RH-PAT was also correlated with disease severity when measured by APACHE-II, SAPS-II and SOFA scores, which is supported by the findings of other authors in sepsis and septic shock [10,25], dengue fever [32], malaria [33,34] and ST-elevation myocardial infarctions [14]. Vasopressors such as epinephrine and norepinephrine are widely used in critical care to treat life-threatening hypotension, especially in patients who do not respond to fluid resuscitation.…”

“…and Nobre et al . , our results suggest that RH-PAT may be an independent predictor of early mortality, and lower ln(RHI) values are associated with higher mortality even after adjusting for confounding factors [ 10 , 25 ]. The improvement in RH-PAT over the disease course in survivors suggests that RH-PAT is acutely impaired in critical illness and that endothelial dysfunction may be reversible.…”

“…Davis et al measured RHI on admission and after 2-4 days in septic patients and found a significant increase that correlated with increasing MAP and decreasing inflammatory markers [10]. In another study with a similar design, Nobre et al also found a significant association between sepsis severity and RH-PAT [25]. However, none of the studies found an association between RH-PAT and mortality, and the authors claimed that the low mortality in both cohorts may have underpowered the results.…”

“…In another study with a similar design, Nobre et al . also found a significant association between sepsis severity and RH-PAT [ 25 ]. However, none of the studies found an association between RH-PAT and mortality, and the authors claimed that the low mortality in both cohorts may have underpowered the results.…”

Reactive hyperemia correlates with the presence of sepsis and glycocalyx degradation in the intensive care unit: a prospective cohort study

“…( 17 , 18 ) Reactive hyperemia-peripheral arterial tonometry is impaired in septic patients compared with healthy controls, but the specificity of this impairment to sepsis compared with other critically ill patients with noninfectious disease remains unknown. ( 23 , 28 - 30 )…”