Sublingual microcirculation and internal environment changes as early indications of sepsis: A prospective observational study

IF 1.9 4区医学 Q3 HEMATOLOGY

Microcirculation Pub Date : 2023-01-30 DOI:10.1111/micc.12801

Yi Lu, Jun Yang, Peng Li, Fei Teng, Shubin Guo

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引用次数: 1

Abstract

Objective

This study aims to investigate the changes in microcirculation and internal environment before sepsis in patients with infectious diseases.

Methods

In this single-center prospective observational study, all patients did not meet the diagnostic criteria of sepsis 3.0 at admission. Blood samples and sublingual microcirculation were collected at admission, 24 and 48 h after admission.

Results

A total of 101 patients completed this study. In total, 46 patients met the diagnostic criteria of sepsis 3.0 within 5 days after admission, while the remaining 55 patients did not. The platelet (PLT) was significantly lower in the sepsis patients (195.17 ± 63.89 vs. 242.02 ± 68.59, p = .01), Microvascular Flow Index (MFI) (2.45 ± 0.33 vs. 2.70 ± 0.18, p = .00) and Proportion of Perfused Vessels (PPV) (92.44 ± 4.45 vs. 95.88 ± 3.20, p = .00) were significantly lower, while Flow Heterogeneity Index (FHI) (0.32 ± 0.13 vs. 0.22 ± 0.10, p = .00) was significantly higher in the in the sepsis patients at admission. Decreased levels of MFI (p = .00, OR 0.02, 95% CI: 0.00, 0.15) and PLT (p = .00, OR 0.99, 95% CI: 0.98, 1.00) were independent risk factors for sepsis. Additionally, the 24 h PLT change rate (AUC 0.85, Cutoff −0.17, sensitivity 0.70, specificity 0.93, and Youden index 0.63) suggested a potential early warning effect for sepsis.

Conclusion

Changes in microcirculation disturbance and the internal environment occurred before sepsis. The MFI and PLT are independent risk factors for sepsis. Sublingual microcirculation and PLT deterioration can be used as early warning indicators before sepsis.

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舌下微循环和内环境变化作为败血症的早期指征:一项前瞻性观察研究

目的探讨感染性疾病患者败血症前微循环及内环境的变化。方法本研究为单中心前瞻性观察性研究，所有患者入院时均未达到脓毒症3.0级诊断标准。入院时、入院后24、48 h采集血液和舌下微循环。结果101例患者完成本研究。共有46例患者在入院后5天内达到脓毒症3.0的诊断标准，其余55例患者未达到。脓毒症患者入院时血小板(PLT)明显降低(195.17±63.89比242.02±68.59,p = 0.01)，微血管流动指数(MFI)(2.45±0.33比2.70±0.18,p = 0.00)和灌注血管比例(PPV)(92.44±4.45比95.88±3.20,p = 0.00)明显降低，血流异质性指数(FHI)(0.32±0.13比0.22±0.10,p = 0.00)明显升高。MFI水平降低(p = 0.00, OR 0.02, 95% CI: 0.00, 0.15)和PLT (p = 0.00, OR 0.99, 95% CI: 0.98, 1.00)是脓毒症的独立危险因素。此外，24 h PLT变化率(AUC 0.85, Cutoff - 0.17，敏感性0.70，特异性0.93,Youden指数0.63)提示脓毒症的潜在预警作用。结论败血症发生前微循环障碍及内环境发生改变。MFI和PLT是脓毒症的独立危险因素。舌下微循环及PLT恶化可作为脓毒症的早期预警指标。

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来源期刊

Microcirculation 医学-外周血管病

CiteScore

5.00

自引率

4.20%

发文量

审稿时长

6-12 weeks

期刊介绍： The journal features original contributions that are the result of investigations contributing significant new information relating to the vascular and lymphatic microcirculation addressed at the intact animal, organ, cellular, or molecular level. Papers describe applications of the methods of physiology, biophysics, bioengineering, genetics, cell biology, biochemistry, and molecular biology to problems in microcirculation. Microcirculation also publishes state-of-the-art reviews that address frontier areas or new advances in technology in the fields of microcirculatory disease and function. Specific areas of interest include: Angiogenesis, growth and remodeling; Transport and exchange of gasses and solutes; Rheology and biorheology; Endothelial cell biology and metabolism; Interactions between endothelium, smooth muscle, parenchymal cells, leukocytes and platelets; Regulation of vasomotor tone; and Microvascular structures, imaging and morphometry. Papers also describe innovations in experimental techniques and instrumentation for studying all aspects of microcirculatory structure and function.