Journal Article

Noninvasive measurements of hemodynamic, autonomic and endothelial function as predictors of mortality in sepsis: A prospective cohort study

Phillips, Shane A., Bonjorno Junior, Jose Carlos, Borghi-Silva, Audrey, Rangel, Francini, Arena, Ross, Caruso, Flávia Rossi, Mendes, Renata Gonçalves, Biazon, Thaís Marina Pires de Campos, da Silva, Tamara Rodrigues

2019

Overview

Sepsis is associated with marked alterations in hemodynamic responses, autonomic dysfunction and impaired vascular function. However, to our knowledge, analysis of noninvasive markers to identify greater risk of death has not yet been investigated. Thus, our aim was to explore the prognostic utility of cardiac output (CO), stroke volume (SV), indices of vagal modulation (RMSSD and SD1), total heart rate variability (HRV) indices and FMD of brachial artery (%FMD), all measured noninvasively, in the first 24 hours of the diagnosis of sepsis. 60 patients were recruited at ICU between 2015 and 2017 and followed by 28 days. CO, SV, RR intervals were measurement. Doppler ultrasound was used to assess brachial artery FMD and the hyperemic response were obtained (%FMD). Patients were divided by survivors (SG) and nonsurvivors groups (NSG). A total of 60 patients were analysed (SG = 21 and NSG = 39). Survivors were younger (41±15 years vs. 55±11 years) and used less vasoactive drugs. As expected, APACHE and SOFA scores were lower in NSG compared to SG. In addition, higher SD1, triangular index, % FMD, velocity baseline and hyperemia flow velocity as well as lower HR values were observed in the SG, compared to NSG (P<0.05). Interestingly, RMSSD and SD1 indices were independent predictors of %FMD, ΔFMD and FMDpeak. RMSSD threshold of 10.8ms and %FMD threshold of -1 were optimal at discriminatomg survivors and nonsurvivors. Noninvasive measurements of autonomic and endotelial function may be important markers of sepsis mortality, which can be easily obtained in the early stages of sepsis at the bedside.

• Publisher: Public Library of Science,Public Library of Science (PLoS)
• Subject: Adult / Age Factors / Aged / Analysis / Autonomic nervous system / Bioengineering / Brachial Artery - physiopathology / Cardiac arrhythmia / Cardiac output / Case-Control Studies / Cellular proteins / Cohort analysis / College campuses / Death / Doppler effect / Electrocardiography / Endothelium / Female / Flow velocity / Health sciences / Heart Rate / Hemodynamic responses / Hemodynamics / Hemodynamics - physiology / Humans / Hyperemia / Inflammation / Intensive care / Intensive Care Units / Ischemia / Kaplan-Meier Estimate / Laboratories / Male / Markers / Medical prognosis / Middle Aged / Mortality / Nitric oxide / Patient outcomes / Patients / Physical therapy / Physiology / Prospective Studies / Regression Analysis / Risk Factors / Sepsis / Sepsis - mortality / Sepsis - pathology / Severity of Illness Index / Stroke / Stroke Volume / Survival / Ultrasound / Vagus nerve / Vasoactive agents / Ventilators