血管截瘫的循环生物标志物:系统综述。

IF 5.5 1区 医学 Q1 CRITICAL CARE MEDICINE
Naomi Boyer, Prateek Upadhyay, Megan H Hicks, Alexander Zarbock, Ashish K Khanna, Lui G Forni, Benedict C Creagh-Brown
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引用次数: 0

摘要

背景:血管截瘫的特征是持续低血压和全身血管阻力降低,尽管心输出量保持不变,通常发生在败血症、大手术后和全身炎症反应中。尽管其具有临床意义并与不良预后相关,但没有普遍接受的定义或标准化的生物标志物,阻碍了早期诊断、分层和靶向治疗。虽然个别研究已经检查了特定临床背景下的生物标志物,如感染性休克或心脏手术,但尚未对血管截瘫的所有病因进行全面综合。目的:系统地评估和综合目前在不同重症监护和围手术期人群中与血管截瘫发生率、严重程度、预测和进展相关的循环生物标志物的证据。以及回顾文献中使用的定义。方法:本系统评价按照PRISMA 2020指南进行,并在PROSPERO注册(CRD42024438786)。如果研究的是重症监护或围手术期血管截瘫的成年患者,则纳入研究。血管截瘫的定义是血管阻力降低和低血压,需要使用血管加压药物。结果:共有43项研究符合纳入标准。纳入的研究检查了39种独特的生物标志物,肾素和肾上腺髓质素是最常被研究的。血管截瘫的定义、结果测量和比较人群的异质性排除了荟萃分析。然而,一些生物标志物显示出潜在的临床用途:肾素水平升高与血管加压素需求和血流动力学不稳定相关,而肾上腺髓质素水平可预测血管截瘫的发展和持续时间。结论:生物标志物测定方法和血管截瘫定义缺乏标准化仍然是比较分析的重大障碍。虽然这篇综述强调肾素和肾上腺髓质素是血管截瘫的有希望的候选生物标志物,但研究设计、生物标志物测量和诊断标准的异质性强调了对血管截瘫的共识定义、标准化采样方案和统一结果测量的迫切需要。未来的研究应侧重于生物标志物引导的风险分层和个性化治疗,重点是验证不同血管截瘫表型的预测和机制作用。
本文章由计算机程序翻译,如有差异,请以英文原文为准。
Circulating biomarkers of vasoplegia: a systematic review.

Background: Vasoplegia is characterised by persistent hypotension and reduced systemic vascular resistance despite preserved cardiac output, commonly arising in sepsis, following major surgery, and within systemic inflammatory responses. Despite its clinical significance and association with poor outcomes, there is no universally accepted definition or standardised biomarker, impeding early diagnosis, stratification, and targeted therapy. While individual studies have examined biomarkers within specific clinical contexts such as septic shock or cardiac surgery, no comprehensive synthesis across all aetiologies of vasoplegia has previously been undertaken.

Objectives: To systematically evaluate and synthesise the current evidence regarding circulating biomarkers associated with the incidence, severity, prediction, and progression of vasoplegia across diverse critical care and perioperative populations. As well as review definitions used across literature.

Methods: This systematic review was conducted in accordance with PRISMA 2020 guidelines and registered on PROSPERO (CRD42024438786). Studies were included if they investigated adult patients in critical care or perioperative settings with vasoplegia defined by reduced vascular resistance and hypotension requiring vasopressors.

Results: A total of 43 studies met inclusion criteria. The included studies examined 39 unique biomarkers, with renin and adrenomedullin being the most frequently studied. Heterogeneity in definitions of vasoplegia, outcome measures, and comparator populations precluded meta-analysis. However, several biomarkers demonstrated potential clinical utility: elevated renin levels correlated with vasopressor requirements and haemodynamic instability, while adrenomedullin levels were predictive of vasoplegia development and duration.

Conclusions: The lack of standardisation in biomarker assay methods and vasoplegia definitions remains a significant barrier to comparative analysis. Whilst this review highlights renin and adrenomedullin as promising candidate biomarkers for vasoplegia, the heterogeneity in study design, biomarker measurement, and diagnostic criteria underscores the urgent need for a consensus definition of vasoplegia, standardised sampling protocols, and unified outcome measures. Future research should focus on biomarker-guided risk stratification and personalised therapies, with an emphasis on validating predictive and mechanistic roles across diverse vasoplegic phenotypes.

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来源期刊
Annals of Intensive Care
Annals of Intensive Care CRITICAL CARE MEDICINE-
CiteScore
14.20
自引率
3.70%
发文量
107
审稿时长
13 weeks
期刊介绍: Annals of Intensive Care is an online peer-reviewed journal that publishes high-quality review articles and original research papers in the field of intensive care medicine. It targets critical care providers including attending physicians, fellows, residents, nurses, and physiotherapists, who aim to enhance their knowledge and provide optimal care for their patients. The journal's articles are included in various prestigious databases such as CAS, Current contents, DOAJ, Embase, Journal Citation Reports/Science Edition, OCLC, PubMed, PubMed Central, Science Citation Index Expanded, SCOPUS, and Summon by Serial Solutions.
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