The prognostic value of peripheral ischemic microvascular reserve in sepsis is not related to calcitonin gene-related peptide or substance P

Miranda, Ana Carolina de; Stefani, Fernanda do Carmo De; Júnior, Hipólito Carraro; Luy, Alain Márcio; Ferreira, Luiz Eduardo Nunes; Morello, Luis Gustavo; Menezes, Igor Alexandre Côrtes de

doi:10.5935/0103-507x.20220102-en

Cited by 1 publication

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“…to play an essential role in the peak/timing of hyperemia [23,24]. Additionally, the neuropeptide substance P and calcitonin gene-related peptide are known markers of severity in sepsis [25][26][27], although we recently demonstrated no significant correlations between these neuropeptides and PIMR in septic patients [28]. One also must remember that sepsis exhibits an essential inflammatory response [29].…”

Section: Plos Onementioning

confidence: 90%

“…Although the pathophysiological mechanisms of PORH in the skin are not fully understood, a report showed that the expression and release of neuropeptides via sensory nerves and derivatives from cytochrome P-450 epoxygenases seem to play an essential role in the peak/timing of hyperemia [ 23 , 24 ]. Additionally, the neuropeptide substance P and calcitonin gene-related peptide are known markers of severity in sepsis [ 25 – 27 ], although we recently demonstrated no significant correlations between these neuropeptides and PIMR in septic patients [ 28 ]. One also must remember that sepsis exhibits an essential inflammatory response [ 29 ].…”

Section: Discussionmentioning

confidence: 99%

“…All data [15] were analyzed using the software IBM-SPSS Statistics 23 and GraphPad Prism-6. The Shapiro-Wilk test was used to verify the normality.…”

Section: Analytical Approachmentioning

confidence: 99%

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Peripheral ischemic reserve in sepsis and septic shock as a new bedside prognostic enrichment tool: A Brazilian cohort study

et al. 2023

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Microvascular dysfunctions are associated with poor prognosis in sepsis. However, the potential role of clinical assessment of peripheral ischemic microvascular reserve (PIMR), a parameter that characterizes the variation of peripheral perfusion index (PPI) after brief ischemia of the upper arm, as a tool to detect sepsis-induced microvascular dysfunction and for prognostic enrichment has not been established. To address this gap, this study investigated the association of high PIMR with mortality over time in patients with sepsis and its subgroups (with and without shock) and peripheral perfusion (capillary-refill time). This observational cohort study enrolled consecutive septic patients in four Intensive-care units. After fluid resuscitation, PIMR was evaluated using the oximetry-derived PPI and post-occlusive reactive hyperemia for two consecutive days in septic patients. Two hundred and twenty-six patients were included—117 (52%) in the low PIMR group and 109 (48%) in the high PIMR group. The study revealed differences in mortality between groups on the first day, which was higher in the high PIMR group (RR 1.25; 95% CI 1.00–1.55; p = 0.04) and maintained its prognostic significance after multivariate adjustment. Subsequently, this analysis was made for sepsis subgroups and showed significant differences in mortality only for the septic-shock subgroup, with was higher in the high PIMR group (RR 2.14; 95% CI 1.49–3.08; p = 0.01). The temporal ΔPPI peak values (%) analyses did not demonstrate maintenance of the predictive value over the first 48 h in either group (p > 0.05). A moderate positive correlation (r = 0.41) between ΔPPI peak (%) and capillary-refill time (s) was found within the first 24 hours of diagnosis (p < 0.001). In conclusion, detecting a high PIMR within 24 h appears to be a prognostic marker for mortality in sepsis. Furthermore, its potential as a prognostic enrichment tool seems to occur mainly in septic shock.

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