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Association of sublingual microcirculation parameters and endothelial glycocalyx dimensions in resuscitated sepsis
BACKGROUND: The endothelial glycocalyx (eGC) covers the luminal surface of the vascular endothelium and plays an important protective role in systemic inflammatory states and particularly in sepsis. Its breakdown leads to capillary leak and organ dysfunction. Moreover, sepsis-induced alterations of...
Autores principales: | , , , , , , , |
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Formato: | Online Artículo Texto |
Lenguaje: | English |
Publicado: |
BioMed Central
2019
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Materias: | |
Acceso en línea: | https://www.ncbi.nlm.nih.gov/pmc/articles/PMC6657098/ https://www.ncbi.nlm.nih.gov/pubmed/31340868 http://dx.doi.org/10.1186/s13054-019-2542-2 |
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author | Rovas, Alexandros Seidel, Laura Mareen Vink, Hans Pohlkötter, Timo Pavenstädt, Hermann Ertmer, Christian Hessler, Michael Kümpers, Philipp |
author_facet | Rovas, Alexandros Seidel, Laura Mareen Vink, Hans Pohlkötter, Timo Pavenstädt, Hermann Ertmer, Christian Hessler, Michael Kümpers, Philipp |
author_sort | Rovas, Alexandros |
collection | PubMed |
description | BACKGROUND: The endothelial glycocalyx (eGC) covers the luminal surface of the vascular endothelium and plays an important protective role in systemic inflammatory states and particularly in sepsis. Its breakdown leads to capillary leak and organ dysfunction. Moreover, sepsis-induced alterations of sublingual microcirculation are associated with a worse clinical outcome. The present study was performed to investigate the associations between eGC dimensions and established parameters of microcirculation dysfunction in sepsis. METHODS: This observational, prospective, cross-sectional study included 40 participants, of which 30 critically ill septic patients were recruited from intensive care units of a university hospital and 10 healthy volunteers served as controls. The established microcirculation parameters were obtained sublingually and analyzed according to the current recommendations. In addition, the perfused boundary region (PBR), an inverse parameter of the eGC dimensions, was measured sublingually, using novel data acquisition and analysis software (GlycoCheck™). Moreover, we exposed living endothelial cells to 5% serum from a subgroup of study participants, and the delta eGC breakdown, measured with atomic force microscopy (AFM), was correlated with the paired PBR values. RESULTS: In septic patients, sublingual microcirculation was impaired, as indicated by a reduced microvascular flow index (MFI) and a reduced proportion of perfused vessels (PPV) compared to those in healthy controls (MFI, 2.93 vs 2.74, p = 0.002; PPV, 98.53 vs 92.58, p = 0.0004). PBR values were significantly higher in septic patients compared to those in healthy controls, indicating damage of the eGC (2.04 vs 2.34, p < 0.0001). The in vitro AFM data correlated exceptionally well with paired PBR values obtained at the bedside (rs = − 0.94, p = 0.02). Both PBR values and microcirculation parameters correlated well with the markers of critical illness. Interestingly, no association was observed between the PBR values and established microcirculation parameters. CONCLUSION: Our findings suggest that eGC damage can occur independently of microcirculatory impairment as measured by classical consensus parameters. Further studies in critically ill patients are needed to unravel the relationship of glycocalyx damage and microvascular impairment, as well as their prognostic and therapeutic importance in sepsis. TRIAL REGISTRATION: Retrospectively registered: Clinicaltrials.gov, NCT03960307 ELECTRONIC SUPPLEMENTARY MATERIAL: The online version of this article (10.1186/s13054-019-2542-2) contains supplementary material, which is available to authorized users. |
format | Online Article Text |
id | pubmed-6657098 |
institution | National Center for Biotechnology Information |
language | English |
publishDate | 2019 |
publisher | BioMed Central |
record_format | MEDLINE/PubMed |
spelling | pubmed-66570982019-07-31 Association of sublingual microcirculation parameters and endothelial glycocalyx dimensions in resuscitated sepsis Rovas, Alexandros Seidel, Laura Mareen Vink, Hans Pohlkötter, Timo Pavenstädt, Hermann Ertmer, Christian Hessler, Michael Kümpers, Philipp Crit Care Research BACKGROUND: The endothelial glycocalyx (eGC) covers the luminal surface of the vascular endothelium and plays an important protective role in systemic inflammatory states and particularly in sepsis. Its breakdown leads to capillary leak and organ dysfunction. Moreover, sepsis-induced alterations of sublingual microcirculation are associated with a worse clinical outcome. The present study was performed to investigate the associations between eGC dimensions and established parameters of microcirculation dysfunction in sepsis. METHODS: This observational, prospective, cross-sectional study included 40 participants, of which 30 critically ill septic patients were recruited from intensive care units of a university hospital and 10 healthy volunteers served as controls. The established microcirculation parameters were obtained sublingually and analyzed according to the current recommendations. In addition, the perfused boundary region (PBR), an inverse parameter of the eGC dimensions, was measured sublingually, using novel data acquisition and analysis software (GlycoCheck™). Moreover, we exposed living endothelial cells to 5% serum from a subgroup of study participants, and the delta eGC breakdown, measured with atomic force microscopy (AFM), was correlated with the paired PBR values. RESULTS: In septic patients, sublingual microcirculation was impaired, as indicated by a reduced microvascular flow index (MFI) and a reduced proportion of perfused vessels (PPV) compared to those in healthy controls (MFI, 2.93 vs 2.74, p = 0.002; PPV, 98.53 vs 92.58, p = 0.0004). PBR values were significantly higher in septic patients compared to those in healthy controls, indicating damage of the eGC (2.04 vs 2.34, p < 0.0001). The in vitro AFM data correlated exceptionally well with paired PBR values obtained at the bedside (rs = − 0.94, p = 0.02). Both PBR values and microcirculation parameters correlated well with the markers of critical illness. Interestingly, no association was observed between the PBR values and established microcirculation parameters. CONCLUSION: Our findings suggest that eGC damage can occur independently of microcirculatory impairment as measured by classical consensus parameters. Further studies in critically ill patients are needed to unravel the relationship of glycocalyx damage and microvascular impairment, as well as their prognostic and therapeutic importance in sepsis. TRIAL REGISTRATION: Retrospectively registered: Clinicaltrials.gov, NCT03960307 ELECTRONIC SUPPLEMENTARY MATERIAL: The online version of this article (10.1186/s13054-019-2542-2) contains supplementary material, which is available to authorized users. BioMed Central 2019-07-24 /pmc/articles/PMC6657098/ /pubmed/31340868 http://dx.doi.org/10.1186/s13054-019-2542-2 Text en © The Author(s). 2019 Open AccessThis 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. The Creative Commons Public Domain Dedication waiver (http://creativecommons.org/publicdomain/zero/1.0/) applies to the data made available in this article, unless otherwise stated. |
spellingShingle | Research Rovas, Alexandros Seidel, Laura Mareen Vink, Hans Pohlkötter, Timo Pavenstädt, Hermann Ertmer, Christian Hessler, Michael Kümpers, Philipp Association of sublingual microcirculation parameters and endothelial glycocalyx dimensions in resuscitated sepsis |
title | Association of sublingual microcirculation parameters and endothelial glycocalyx dimensions in resuscitated sepsis |
title_full | Association of sublingual microcirculation parameters and endothelial glycocalyx dimensions in resuscitated sepsis |
title_fullStr | Association of sublingual microcirculation parameters and endothelial glycocalyx dimensions in resuscitated sepsis |
title_full_unstemmed | Association of sublingual microcirculation parameters and endothelial glycocalyx dimensions in resuscitated sepsis |
title_short | Association of sublingual microcirculation parameters and endothelial glycocalyx dimensions in resuscitated sepsis |
title_sort | association of sublingual microcirculation parameters and endothelial glycocalyx dimensions in resuscitated sepsis |
topic | Research |
url | https://www.ncbi.nlm.nih.gov/pmc/articles/PMC6657098/ https://www.ncbi.nlm.nih.gov/pubmed/31340868 http://dx.doi.org/10.1186/s13054-019-2542-2 |
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