Association between increased arterial stiffness and clinical outcomes in patients with early sepsis: a prospective observational cohort study

Abstract

Background Conduit arteries, especially the aorta, play a major role in ensuring efficient cardiac function and optimal microvascular flow due to their viscoelastic properties. Studies in animals and on isolated arteries show that acute systemic inflammation can cause aortic stiffening which affects hemodynamic efficiency. Carotid-femoral pulse wave velocity, a measure of aortic stiffness, may be useful as a bedside investigational method in patients with early sepsis admitted to intensive care, as circulatory changes can lead to multiple organ failure and increased mortality. This study aims to investigate arterial stiffness in early sepsis and its association with clinical outcomes. Methods This prospective observational study included adult patients with severe sepsis or septic shock admitted to our intensive care unit ( n = 45). Their carotid-femoral pulse wave velocity was measured within 24 h of admission. We assessed the progression of multiple organ as well as cardiovascular failure by sequential SOFA scores. Prediction models for the progression of multiple organ and cardiovascular failure were constructed using multivariate logistic regression with pulse wave velocity and vasopressor use as predictors. A Cox proportional hazards model was used to examine the relationship between pulse wave velocity and survival time. Results The median pulse wave velocity for the cohort was 14.6 (8.1–24.7) m/s. There was no association between pulse wave velocity and the progression of multiple organ failure, before or after adjustment for vasopressor use. No association was found between pulse wave velocity and subsequent improvement in cardiovascular failure in the subgroup of patients who had cardiovascular instability at baseline. Cox regression and survival analyses with age, APACHE II, and baseline SOFA as confounders showed a shorter hospital survival time for patients with pulse wave velocity > 24.7 m/s (HR = 9.45, 95% CI 1.24–72.2; P = 0.03). Conclusions Patients with severe sepsis and septic shock admitted to intensive care have higher arterial stiffness than in the general population. No convincing association was found between pulse wave velocity at admission and the progression of multiple organ or cardiovascular failure, although the group with pulse wave velocity > 24.7 m/s had shorter survival time. Electronic supplementary material The online version of this article (10.1186/s40635-019-0252-3) contains supplementary material, which is available to authorized users.

Vascular Decoupling in Septic Shock: The Combined Role of Autonomic Nervous System, Arterial Stiffness, and Peripheral Vascular Tone

“…For example, LPS injection in rabbits has been shown to induce a dysfunction of the endothelium-mediated vascular relaxation in the aorta (Leclerc et al, 2000), and additional experimental observations in endotoxin shock swine model confirmed an increased stiffness of the central aorta and, on the opposite, an increase in compliance of the peripheral compartment generated by septic shock (Hatib et al, 2011). Finally, a recent clinical observational study on arterial elastic properties has shown an increase in aortic stiffness, with respect to the general population, in a cohort of septic shock patients when pulse wave velocity (PWV, an indirect measure of arterial stiffness in large arteries) was measured at the time of admission (Kazune et al, 2019).…”

Feasibility of non‐invasive measurement of central blood pressure and arterial stiffness in shock

“…Though, the use of SphygmoCor, Mobil-o-Graph PWA and other non-invasive devices in ICU patients has been investigated in previous studies; our study is the first one having as primary endpoint checking the feasibility of these methods in respect to central and peripheral blood pressure estimation and using as comparison the invasive blood pressure values. [11][12][13][14][15] Moreover, unlike previous studies, our study population consisted entirely of patients with septic or cardiogenic shock with the vast majority of them receiving catecholamines and no mechanical assistances such as intra-aortic balloon pump. Non-invasive assessment failure was more pronounced with the SphygmoCor XCEL.…”

“…SphygmoCor, Mobil-o-Graph ® 24 hours PWA and other arterial stiffness measuring techniques were applied on ICU (intensive care unit) patients in previous studies. [11][12][13][14][15] However, only a subset of the patients included in these studies were diagnosed with shock or the study endpoint was not focused on central blood pressure and arterial stiffness estimation. Albeit, these devices offer the chance for a new attempt to compare invasive and non-invasive blood pressure monitoring on an intensive care unit.…”

Cox-LASSO Analysis for Hospital Mortality in Patients With Sepsis Received Continuous Renal Replacement Therapy: A MIMIC-III Database Study

“…Improvement of hemodynamic may not be related to the improvement of microcirculation (4,9). Septic shock is defined as a microcirculation disease, and many trials showed that the severity of microvascular alterations is associated with outcomes in patients with septic shock (10)(11)(12)(13)(14). Evaluation of the response for hemodynamic management is critical for the prognosis of sepsis.…”