一氧化氮生物标志物与危重病人循环衰竭：一项队列研究

IF 3.2 3区医学 Q2 CRITICAL CARE MEDICINE

Journal of critical care Pub Date : 2025-04-16 DOI:10.1016/j.jcrc.2025.155083

Karoline Myglegård Mortensen , Morten Heiberg Bestle , Jakob Stensballe , Thore Hillig , Claus Antonio Juel Jensen , Martin Schønemann-Lund , Theis Skovsgaard Itenov

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引用次数: 0

摘要

目的腹壁低血压是危重症患者的常见病。一氧化氮（NO）在血管舒张中起关键作用。我们研究了no生物标志物（不对称二甲基精氨酸（ADMA）、对称二甲基精氨酸（SDMA）、精氨酸和同型精氨酸）与ICU第1-3天去甲肾上腺素和血浆乳酸治疗之间的关系。材料与方法对527例入院时无生物标志物的ICU成人患者进行前瞻性队列研究。在ICU入院前3天进行logistic回归分析与去甲肾上腺素治疗的关系。用线性混合模型分析与最高日血浆乳酸的关系。结果ADMA和精氨酸升高与去甲肾上腺素治疗减少相关(ICU第1天：OR 0.36 pr 1 μmol/L ADMA, 95% CI 0.17-0.78；p = 0.009, OR = 0.85 pr = 10 μmol/L精氨酸；95% ci 0.79-0.92；p & lt;0.001)。同型精氨酸每增加1 μmol/L，血浆乳酸水平从ICU第1 -2天增加6% (95% CI -2 % ~ 15%)，从ICU第2-3天增加4% （95% CI -4 % ~ 13%）。SDMA与两种结果均无相关性。结论入院时ADMA和精氨酸升高与入院前3天去甲肾上腺素治疗减少有关。高精氨酸浓度与血浆乳酸升高有关。

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Nitric oxide biomarkers and circulatory failure in critical illness: A cohort study

Purpose

Arterial hypotension is frequently observed in critically ill patients. Nitric oxide (NO) is pivotal in vasodilation. We investigated the associations between NO-biomarkers (asymmetrical dimethylarginine (ADMA), symmetric dimethylarginine (SDMA), arginine, and homoarginine) and treatment with norepinephrine and plasma lactate on ICU days 1–3.

Materials and methods

A prospective cohort study of 527 adult ICU patients with NO-biomarkers at admission. Associations with norepinephrine treatment were analyzed in logistic regressions on the first three days of ICU admission. Associations with the highest daily plasma lactate were analyzed with linear mixed models.

Results

Increasing ADMA and arginine were associated with decreased norepinephrine treatment (ICU day 1: OR 0.36 pr 1 μmol/L ADMA, 95 % CI 0.17–0.78; p = 0.009, and OR 0.85 pr 10 μmol/L arginine; 95 % CI 0.79–0.92; p < 0.001). An increase in homoarginine of 1 μmol/L was associated with an increase in plasma lactate of 6 % (95 % CI -2 % to 15 %) from ICU days 1–2 and 4 % (95 % CI -4 % to 13 %) from ICU days 2–3. SDMA was not associated with either outcome.

Conclusions

Increased ADMA and arginine at admission are associated with decreased norepinephrine treatment on the first three days of ICU admission. Increased homoarginine concentrations are associated with increasing plasma lactate.

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来源期刊

Journal of critical care 医学-危重病医学

CiteScore

8.60

自引率

2.70%

发文量

237

审稿时长

23 days

期刊介绍： The Journal of Critical Care, the official publication of the World Federation of Societies of Intensive and Critical Care Medicine (WFSICCM), is a leading international, peer-reviewed journal providing original research, review articles, tutorials, and invited articles for physicians and allied health professionals involved in treating the critically ill. The Journal aims to improve patient care by furthering understanding of health systems research and its integration into clinical practice. The Journal will include articles which discuss: All aspects of health services research in critical care System based practice in anesthesiology, perioperative and critical care medicine The interface between anesthesiology, critical care medicine and pain Integrating intraoperative management in preparation for postoperative critical care management and recovery Optimizing patient management, i.e., exploring the interface between evidence-based principles or clinical insight into management and care of complex patients The team approach in the OR and ICU System-based research Medical ethics Technology in medicine Seminars discussing current, state of the art, and sometimes controversial topics in anesthesiology, critical care medicine, and professional education Residency Education.