Shock Resuscitation - the Necessity and Priority of Renal Blood Perfusion Assessment

Liu, Lixia; Chao, Yangong; Wang, Xiaoting

doi:10.14336/ad.2022.0105

Cited by 6 publications

(5 citation statements)

References 40 publications

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“…Previous reports have demonstrated that AAO could result in abnormal kidney, liver and heat function [4,21,22]. Our study showed that renal function and cardiac function were significantly impaired in the AAO model, and HyC reversed the injury.…”

Section: Discussionsupporting

confidence: 65%

Hypoxic Conditioning: A Potential Perioperative Strategy to Reduce Abdominal Aortic Occlusion-Related Injury in Mouse Proximal and Distal Organs

2024

Aging dis

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This study aimed to investigate the impact of abdominal aortic occlusion (AAO)-induced injury on the kidney, lower limb muscles, heart, and brain in mice, and the potential protective effects of hypoxic postconditioning (HyC). The experimental design employed an abdominal aortic occlusion (AAO) model, and involved three groups of mice: sham, AAO, and AAO+HyC. Ten minutes after the AAO model, mice were subjected to hypoxic treatment lowering oxygen concentration to 5% within 45 minutes, and then returned to a normal oxygen environment. Hematoxylin-eosin (HE) stain was used for Histopathological examinations, and Quantibody Mouse Array was used for detecting apoptosis and inflammation-related protein expression. Histopathological examinations showed that HyC mitigated pathological damage to proximal organs (kidneys and lower limb muscles), distal organs (heart and brain), and reduced inflammatory cell infiltration. Expression of apoptosis-and inflammation-related proteins in brain and heart tissues were also evaluated. HyC significantly increased cellular inhibitor of apoptosis 2 (cIAP2) in the brain and Bcl-2 and insulin-like growth factor 2 (IGF-2) in the heart. Additionally, HyC regulated the expression of several inflammation-related factors in both brain and heart tissues. Although further investigation is needed, particularly in human subjects, this study highlights the potential of HyC as a promising therapeutic strategy for reducing AAO-associated organ damage.

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Section: Discussionsupporting

confidence: 65%

Hypoxic Conditioning: A Potential Perioperative Strategy to Reduce Abdominal Aortic Occlusion-Related Injury in Mouse Proximal and Distal Organs

2024

Aging dis

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“…Sepsis is a life-threatening organ dysfunction resulting from a dysregulated host response to infection, and 50% of sepsis patients may experience AKI [1,2]. Renal perfusion plays a crucial role in this process [5,16,23]. The de nition of MAKE-30 encompasses death or the initiation of new renal replacement therapy for any reason and is recommended by the American Diabetes and Digestive and Kidney Diseases Institute working group as a "hard endpoint" for short-term or long-term evolution of AKI [24].…”

Section: Discussionmentioning

confidence: 99%

“…Blood ow perfusion is fundamental to organ function, particularly in the case of the kidneys [5]. The conventional view attributing sepsis AKI to renal tubular cell necrosis caused by renal ischemia has been challenged [6,7], with some studies suggesting that renal perfusion may not decrease and could even increase during sepsis [8][9][10][11][12].…”

Section: Introductionmentioning

confidence: 99%

Decreased Renal Cortical Perfusion Post-EGDT in Sepsis: Implications for MAKE-30 and the Influential Role of CVP

Li,

Wang

et al. 2024

Preprint

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Objective: Renal perfusion during sepsis remains a relatively unexplored area. This study aims to delve into alterations in renal cortical perfusion following Early Goal-Directed Therapy (EGDT) in patients with sepsis. We investigate its implications on major adverse kidney events within 30 days (MAKE-30) and endeavor to pinpoint hemodynamic factors that influence renal cortical perfusion. Methods: We prospectively enrolled sepsis patients admitted to the intensive care unit from January 2022 to July 2023. After EGDT, contrast-enhanced ultrasound (CEUS) was used to assess cortical renal perfusion. Hemodynamic parameters, including cardiac index (CI) and mean arterial pressure (MAP) as indicators of renal forward perfusion, central venous pressure (CVP), oxygen metabolism parameters (SvO2 - mixed venous oxygen saturation, and Gapv-aCO2 - venous-arterial carbon dioxide gradient, lactate levels), and renal resistive index (RRI), were systematically collected from the patients.Patients were divided into major adverse kidney events within 30 days (MAKE-30) and non-major adverse kidney events within 30 days (non-MAKE-30) groups. The study scrutinized the influence of renal cortical perfusion on MAKE-30 and elucidated the hemodynamic determinants affecting cortical perfusion. Results: The study included 65 sepsis patients, with 31 patients (47.7%) experiencing MAKE-30 (including 11 deaths, 25 with creatinine elevation exceeding baseline by 200%, and 11 undergoing renal replacement therapy). The remaining 34 patients had no-MAKE-30. A noteworthy distinction in abdominal infection sites was observed between the two groups (P=0.009). Significant differences in SOFA and APACHE II scores were also noted (P=0.001 and 0.004, respectively). Additional baseline characteristics (such as vasopressor doses and diuretic doses) showed no significant differences (P>0.05). In sepsis patients MAKE-30 and non-MAKE-30, hemodynamic parameters including MAP, CI, CVP, and lactate showed no significant differences (p=0.662, p=0.754, p=0.353) and were within the normal range. RRI was significantly higher in sepsis patients with MAKE-30(p=0.001). Parameters of renal microcirculation perfusion, including area under the curve (AUC) (p=0.048), along with relative blood volume (rBV) (p=0.013) and perfusion index (PI) (p=0.008), were significantly lower in MAKE-30 patients, while RT(RT≥16.92) was significantly prolonged. sepsis patients with reduced cortical renal perfusion had an increased risk of MAKE-30. Renal cortical perfusion Rise time(RT) was identified as an independent influencing factor for MAKE-30 (HR 1.092, 95% CI 1.017–1.173, P=0.015). CVP showed correlations with renal cortical perfusion RT and PI (correlation coefficients r were -0.29 and 0.273, p<0.05). Conclusion: Despite normal systemic hemodynamic indicators after sepsis EGDT, MAKE-30 patients exhibit reduced renal cortical perfusion, and CEUS-derived renal cortical perfusion parameter RT is an independent influencing factor. Renal cortical perfusion and CVP are significantly correlated, and CVP may be a simple and easily obtainable indicators to reflect renal cortical perfusion in sepsis patients.

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“…In addition to the systemic in ammatory response, our mice also demonstrated multiple organ damage. Because the kidneys are more susceptible to changes in pressure and perfusion than other organs [17], kidney damage occurred in the early post-CLP stage and persisted thereafter; in contrast, liver, heart, and lung damage gradually intensi ed as sepsis progressed after CLP.…”

Section: Discussionmentioning

confidence: 99%

Characterization of Krüppel-like factor 3 expression in T lymphocytes in septic mice

Yan,

Chi,

Wang

et al. 2024

Preprint

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Background Krüppel-like factor 3 (KLF3) may be involved in the regulation of inflammatory responses and lymphocyte function. Moreover, immune dysfunction in sepsis involves both hyperinflammatory responses and immunosuppression. However, studies on T-lymphocyte KLF3 expression characteristics in sepsis are lacking. Methods We induced sepsis in mice through cecal ligation and puncture (CLP) and evaluated their survival rate over 7 days. To identify the immune status of the septic mice, we assessed their cytokine levels, organ damage scores, and splenic T-lymphocyte phenotype. Finally, KLF3 expression in T lymphocytes was detected through flow cytometry. Results Over the 7 days of observation, septic mice demonstrated 64.7% mortality. In the early stages after CLP, the proinflammatory and anti-inflammatory cytokine levels increased rapidly, multiple organ damage occurred, and splenic T lymphocytes became activated (with an increase in the proportions of CD69+ cells and mean fluorescence intensity for CD71). However, the proportion of KLF3+ T lymphocytes decreased. Subsequently, cytokine levels and lymphocyte activation decreased. An increase in cell apoptosis led to a substantial loss of T lymphocytes. Considering the continual elevations in serum interleukin 10 and interleukin 6 levels and worsening severe organ damage, the septic mice may have entered a state of chronic inflammation and immunosuppression, with a simultaneous increase in KLF3 expression in T lymphocytes, in the later stages after CLP. Conclusions In septic mice, T-lymphocyte KLF3 expression decreased in the early stage after CLP (i.e., systemic inflammatory response and T-lymphocyte activation stage) but increased in the later stage (i.e., chronic inflammation and immunosuppression stage). As such, KLF3 may be a promising target for dynamic immune monitoring and immunomodulatory therapy for sepsis.

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Shock Resuscitation - the Necessity and Priority of Renal Blood Perfusion Assessment

Cited by 6 publications

References 40 publications

Hypoxic Conditioning: A Potential Perioperative Strategy to Reduce Abdominal Aortic Occlusion-Related Injury in Mouse Proximal and Distal Organs

Hypoxic Conditioning: A Potential Perioperative Strategy to Reduce Abdominal Aortic Occlusion-Related Injury in Mouse Proximal and Distal Organs

Decreased Renal Cortical Perfusion Post-EGDT in Sepsis: Implications for MAKE-30 and the Influential Role of CVP

Characterization of Krüppel-like factor 3 expression in T lymphocytes in septic mice

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