Reactive hyperemia correlates with the presence of sepsis and glycocalyx degradation in the intensive care unit: a prospective cohort study

Abstract Objective: To investigate whether reactive hyperemia measured by peripheral arterial tonometry correlates with markers of endothelial dysfunction and may be used to identify sepsis in critical illness. Methods: A prospective study was performed using a cohort of critically ill patients. Endothelial dysfunction was assessed on admission by quantifying reactive hyperemia-peripheral arterial tonometry and plasma levels of endothelin-1, soluble E-selectin, endocan and syndecan-1. Septic patients were compared to patients without evidence of infection. Results: Fifty-eight septic patients were compared to 28 controls. The natural logarithm of reactive hyperemia-peripheral arterial tonometry was negatively correlated with cardiovascular comorbidities, disease severity and plasma levels of soluble E-selectin (p = 0.024) and syndecan-1 (p < 0.001). The natural logarithm of reactive hyperemia-peripheral arterial tonometry was lower in septic patients than in controls (0.53 ± 0.48 versus 0.69 ± 0.42, respectively). When adjusted for age, the multivariable model predicted that each 0.1-unit decrease in natural logarithm of reactive hyperemia-peripheral arterial tonometry increased the odds for infection by 14.6%. m. Conclusion: Reactive hyperemia-peripheral arterial tonometry is closely related to soluble E-selectin and syndecan-1, suggesting an association between endothelial activation, glycocalyx degradation and vascular reactivity. Reactive hyperemia-peripheral arterial tonometry appears to be compromised in critically ill patients, especially those with sepsis.

【研究目的】探讨经外周动脉张力测定法（reactive hyperemia-peripheral arterial tonometry）测得的反应性充血，是否与内皮功能障碍标志物相关，且能否用于识别重症患者中的脓毒症。
【研究方法】本研究针对重症患者队列开展前瞻性研究。于患者入院时，通过定量检测反应性充血-外周动脉张力测定法结果，以及血浆内皮素-1（endothelin-1）、可溶性E选择素（soluble E-selectin）、内皮细胞特异性分子-1（endocan）与多配体蛋白聚糖-1（syndecan-1）的水平，评估内皮功能障碍。将脓毒症患者与无感染证据的患者进行对照比较。
【研究结果】本研究共纳入58例脓毒症患者与28例对照受试者。反应性充血-外周动脉张力测定法的自然对数结果与心血管合并症、疾病严重程度，以及可溶性E选择素（p=0.024）、多配体蛋白聚糖-1（p<0.001）的血浆水平呈负相关。脓毒症患者的反应性充血-外周动脉张力测定法自然对数结果低于对照组（分别为0.53±0.48与0.69±0.42）。在校正年龄因素后，多变量模型预测显示，反应性充血-外周动脉张力测定法自然对数每降低0.1个单位，感染发生的比值升高14.6%。
【研究结论】反应性充血-外周动脉张力测定法与可溶性E选择素、多配体蛋白聚糖-1密切相关，提示内皮激活、糖萼降解与血管反应性之间存在关联。重症患者，尤其是合并脓毒症的患者，其反应性充血-外周动脉张力测定法所反映的血管反应性存在受损。