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Association between increased arterial stiffness and clinical outcomes in patients with early sepsis: a prospective observational cohort study
Intensive Care Medicine Experimental Pub Date : 2019-05-16 , DOI: 10.1186/s40635-019-0252-3
Sigita Kazune 1, 2, 3 , Andris Grabovskis 2 , Corrado Cescon 4 , Eva Strike 3, 5 , Indulis Vanags 3
Affiliation  

BackgroundConduit 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.MethodsThis 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.ResultsThe 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).ConclusionsPatients 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.

中文翻译:

早期脓毒症患者动脉僵硬度增加与临床结果之间的关联:一项前瞻性观察队列研究

背景导管动脉,尤其是主动脉,由于其粘弹性特性,在确保有效的心脏功能和最佳微血管流动方面发挥着重要作用。对动物和离体动脉的研究表明,急性全身炎症可导致主动脉硬化,从而影响血液动力学效率。颈动脉-股动脉脉搏波速度是主动脉僵硬度的一种测量方法,可用作重症监护室早期败血症患者的床边研究方法,因为循环变化可导致多器官衰竭和死亡率增加。本研究旨在调查早期脓毒症的动脉僵硬度及其与临床结果的关联。方法这项前瞻性观察性研究包括入住我们重症监护病房的严重脓毒症或感染性休克成年患者(n = 45)。在入院后 24 小时内测量了他们的颈股脉搏波速度。我们通过连续 SOFA 评分评估了多器官和心血管衰竭的进展。使用多变量逻辑回归构建多器官和心血管衰竭进展的预测模型,脉搏波速度和血管加压药用作预测因子。Cox 比例风险模型用于检查脉搏波速度与生存时间之间的关系。结果队列的中位脉搏波速度为 14.6 (8.1–24.7) m/s。在调整血管加压药使用之前或之后,脉搏波速度与多器官衰竭的进展之间没有关联。在基线时心血管不稳定的患者亚组中,未发现脉搏波速度与随后心血管衰竭的改善之间存在关联。以年龄、APACHE II 和基线 SOFA 作为混杂因素的 Cox 回归和生存分析显示,脉搏波速度 > 24.7 m/s 的患者住院生存时间较短(HR = 9.45,95% CI 1.24–72.2;P = 0.03)。结论重症脓毒症和感染性休克患者入住重症监护室的动脉僵硬度高于一般人群。尽管脉搏波速度 > 24.7 m/s 组的生存时间较短,但在入院时的脉搏波速度与多器官或心血管衰竭的进展之间没有发现令人信服的关联。以年龄、APACHE II 和基线 SOFA 作为混杂因素的 Cox 回归和生存分析显示,脉搏波速度 > 24.7 m/s 的患者住院时间较短(HR = 9.45,95% CI 1.24–72.2;P = 0.03)。结论重症脓毒症和感染性休克患者入住重症监护室的动脉僵硬度高于一般人群。尽管脉搏波速度 > 24.7 m/s 组的生存时间较短,但在入院时的脉搏波速度与多器官或心血管衰竭的进展之间没有发现令人信服的关联。以年龄、APACHE II 和基线 SOFA 作为混杂因素的 Cox 回归和生存分析显示,脉搏波速度 > 24.7 m/s 的患者住院时间较短(HR = 9.45,95% CI 1.24–72.2;P = 0.03)。结论重症脓毒症和感染性休克患者入住重症监护室的动脉僵硬度高于一般人群。尽管脉搏波速度 > 24.7 m/s 组的生存时间较短,但在入院时的脉搏波速度与多器官或心血管衰竭的进展之间没有发现令人信服的关联。结论重症脓毒症和感染性休克患者入住重症监护室的动脉僵硬度高于一般人群。尽管脉搏波速度 > 24.7 m/s 组的生存时间较短,但在入院时的脉搏波速度与多器官或心血管衰竭的进展之间没有发现令人信服的关联。结论重症脓毒症和感染性休克患者入住重症监护室的动脉僵硬度高于一般人群。入院时的脉搏波速度与多器官或心血管衰竭的进展之间没有令人信服的关联,尽管脉搏波速度 > 24.7 m/s 的组生存时间较短。
更新日期:2019-05-16
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