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

Abstract

Predictions of mortality may help in the selection of patients who benefit from intensive care. Endothelial dysfunction is partially responsible for many of the organic dysfunctions in critical illness. Reactive hyperaemia is a vascular response of the endothelium that can be measured by peripheral arterial tonometry (RH-PAT). We aimed to assess if reactive hyperaemia is affected by critical illness and if it correlates with outcomes. Prospective study with a cohort of consecutive patients admitted to an Intensive Care Unit. RH-PAT was accessed on admission and on the 7th day after admission. Early and late survivors were compared to non-survivors. The effect of RH-PAT variation on late mortality was studied by a logistic regression model. The association between RH-PAT and severity scores and biomarkers of organic dysfunction was investigated by multivariate analysis. 86 patients were enrolled. Mean ln(RHI) on admission was 0.580 and was significantly lower in patients with higher severity scores (p < 0.01) and early non-survivors (0.388; p = 0.027). The model for prediction of early-mortality estimated that each 0.1 decrease in ln(RHI) increased the odds for mortality by 13%. In 39 patients, a 2nd RH-PAT measurement was performed on the 7th day. The variation of ln(RHI) was significantly different between non-survivors and survivors (− 24.2% vs. 63.9%, p = 0.026). Ln(RHI) was significantly lower in patients with renal and cardiovascular dysfunction (p < 0.01). RH-PAT is correlated with disease severity and seems to be an independent marker of early mortality, cardiovascular and renal dysfunctions. RH-PAT variation predicts late mortality. There appears to be an RH-PAT impairment in the acute phase of severe diseases that may be reversible and associated with better outcomes.

Dynamics of Local Temperature in the Fingertips After the Cuff Occlusion Test: Infrared Diagnosis of Adaptation Reserves to Hypoxia and Assessment of Survivability of Victims at Massive Blood Loss

“…The fact is that the true cause of death in hemorrhagic shock is hypoxic brain damage. At the same time, the danger of massive hemorrhage is still estimated by the volume and severity of blood loss, rather than by the severity of hypoxia and the reserves of adaptation to it [ 23 ].…”

MicroRNAs as the promising markers of comorbidities in childhood obesity—A systematic review

“…Condition of endothelium as a whole can be inspected via levels of endothelial products, such as NO and ET‐1, their ratio (NO/ET‐1) or through functional test – RHI measurement, whose score is dependent on endothelial reaction engaging NO. 43 , 44 Some miRNAs play an established role in physiology of endothelium, angiogenesis, although they have not been yet applied clinically as the markers of endothelial dysfunction. 45 , 46 …”

“…Condition of endothelium as a whole can be inspected via levels of endothelial products, such as NO and ET-1, their ratio (NO/ET-1) or through functional test -RHI measurement, whose score is dependent on endothelial reaction engaging NO. 43,44 Some miRNAs play an established role in physiology of endothelium, angiogenesis, although they have not been yet applied clinically as the markers of endothelial dysfunction. 45,46 Physical activity is one of the factors contributing to healthy Method used for the measurement of RHIperipheral arterial tonometryis highly dependent on age and sex of subjects, 47 therefore the uniformity of groups in this regard is highly required.…”