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Association between increased arterial stiffness and clinical outcomes in patients with early sepsis: a prospective observational cohort study
BACKGROUND: Conduit 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 affect...
Autores principales: | , , , , |
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Formato: | Online Artículo Texto |
Lenguaje: | English |
Publicado: |
Springer International Publishing
2019
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Materias: | |
Acceso en línea: | https://www.ncbi.nlm.nih.gov/pmc/articles/PMC6522594/ https://www.ncbi.nlm.nih.gov/pubmed/31098834 http://dx.doi.org/10.1186/s40635-019-0252-3 |
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author | Kazune, Sigita Grabovskis, Andris Cescon, Corrado Strike, Eva Vanags, Indulis |
author_facet | Kazune, Sigita Grabovskis, Andris Cescon, Corrado Strike, Eva Vanags, Indulis |
author_sort | Kazune, Sigita |
collection | PubMed |
description | BACKGROUND: Conduit 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. METHODS: This 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. RESULTS: The 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). CONCLUSIONS: Patients 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. ELECTRONIC SUPPLEMENTARY MATERIAL: The online version of this article (10.1186/s40635-019-0252-3) contains supplementary material, which is available to authorized users. |
format | Online Article Text |
id | pubmed-6522594 |
institution | National Center for Biotechnology Information |
language | English |
publishDate | 2019 |
publisher | Springer International Publishing |
record_format | MEDLINE/PubMed |
spelling | pubmed-65225942019-06-05 Association between increased arterial stiffness and clinical outcomes in patients with early sepsis: a prospective observational cohort study Kazune, Sigita Grabovskis, Andris Cescon, Corrado Strike, Eva Vanags, Indulis Intensive Care Med Exp Research BACKGROUND: Conduit 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. METHODS: This 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. RESULTS: The 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). CONCLUSIONS: Patients 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. ELECTRONIC SUPPLEMENTARY MATERIAL: The online version of this article (10.1186/s40635-019-0252-3) contains supplementary material, which is available to authorized users. Springer International Publishing 2019-05-16 /pmc/articles/PMC6522594/ /pubmed/31098834 http://dx.doi.org/10.1186/s40635-019-0252-3 Text en © The Author(s). 2019 Open Access This article is distributed under the terms of the Creative Commons Attribution 4.0 International License (http://creativecommons.org/licenses/by/4.0/), which permits unrestricted use, distribution, and reproduction in any medium, provided you give appropriate credit to the original author(s) and the source, provide a link to the Creative Commons license, and indicate if changes were made. |
spellingShingle | Research Kazune, Sigita Grabovskis, Andris Cescon, Corrado Strike, Eva Vanags, Indulis Association between increased arterial stiffness and clinical outcomes in patients with early sepsis: a prospective observational cohort study |
title | Association between increased arterial stiffness and clinical outcomes in patients with early sepsis: a prospective observational cohort study |
title_full | Association between increased arterial stiffness and clinical outcomes in patients with early sepsis: a prospective observational cohort study |
title_fullStr | Association between increased arterial stiffness and clinical outcomes in patients with early sepsis: a prospective observational cohort study |
title_full_unstemmed | Association between increased arterial stiffness and clinical outcomes in patients with early sepsis: a prospective observational cohort study |
title_short | Association between increased arterial stiffness and clinical outcomes in patients with early sepsis: a prospective observational cohort study |
title_sort | association between increased arterial stiffness and clinical outcomes in patients with early sepsis: a prospective observational cohort study |
topic | Research |
url | https://www.ncbi.nlm.nih.gov/pmc/articles/PMC6522594/ https://www.ncbi.nlm.nih.gov/pubmed/31098834 http://dx.doi.org/10.1186/s40635-019-0252-3 |
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