Endothelial dysfunction assessed by brachial artery ultrasound in severe sepsis and septic shock

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• 作者：Leandro Becker ; MD ; MSc ^{lqbecker@terra.com.br} ; Karen Prado ; MD ; MSc ^{karen@portoweb.com.br} ; Murilo Foppa ; MD ; ScD ^{mfoppa@cpovo.net} ; Nidiane Martinelli ; BSc ^{ncmartinelli@gmail.com} ; Cynthia Aguiar ; MD ; MSc ^{cyntiari@terra.com.br} ; Thiago Furian ; MD ; MSc ^{furian@terra.com.br} ; Nadine Clausell ; MD ; PhD ^{clausell@portoweb.com.br} ; Luis Eduardo Rohde ; MD ; ScD ; ^{lerohde@terra.com.br}
• 关键词：Sepsis ; Endothelial Function ; Mortality
• 刊名：Journal of Critical Care
• 出版年：2012
• 期刊代码：167_08839441
• 类别：med
• 出版时间：June, 2012
• 卷：27
• 期：3
• 页码：316.e9-316.e14
• 文件大小：301 K

摘要

Purpose

Noninvasive evaluation of endothelial function may be accomplished by ultrasound assessment of flow-mediated vasodilation (FMD) of the brachial artery. This study aims to investigate the role of FMD analysis on intrahospital prognosis of patients with sepsis.

Methods

Adult patients admitted to the intensive care unit with severe sepsis or septic shock were consecutively included. Brachial artery FMD was measured upon admission, after 24 and 72 hours. A group of apparently healthy subjects paired for sex and age was used as controls. Patients were followed up to discharge or death.

Results

We studied 42 patients (mean age, 51 卤 19 years) with sepsis predominantly of abdominal or respiratory etiology (75%). Acute Physiology And Chronic Health Evaluation II risk score was 23 卤 7, and intrahospital mortality rate was 33%. Flow-mediated vasodilation in septic patients was significantly lower than in healthy controls (1.5 卤 7%vs 6 卤 4%, P < .001). Most of the nonsurvivors (86%) showed a decline in sequential FMD analyses, whereas only 43%of survivors showed a reduction of FMD (P = .01). In nonsurvivors, FMD was significantly lower 72 hours after sepsis onset (鈭?.3%卤 10%vs 5.2%卤 4%; P < .05; time-group interaction P value = .03).

Conclusions

Brachial FMD is altered in septic patients with hemodynamic instability, and its deterioration may be an early marker of unfavorable prognosis.