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https://www.arca.fiocruz.br/handle/icict/60731
RELATIONSHIP BETWEEN PERIPHERAL ISCHEMIC MICROVASCULAR RESERVE, PERSISTENT HYPERLACTATEMIA, AND ITS TEMPORAL DYNAMICS IN SEPSIS: A POST HOC STUDY
Author
Affilliation
Universidade Federal do Paraná. Hospital das Clínicas. Departamento de Medicina Interna. Curitiba, PR, Brasil.
Universidade Federal do Paraná. Hospital das Clínicas. Unidade de Terapia Intensiva. Curitiba, PR.
Universidade Federal do Paraná. Hospital das Clínicas. Unidade de Terapia Intensiva. Curitiba, PR.
Universidade Federal do Paraná. Hospital das Clínicas. Unidade de Terapia Intensiva. Curitiba, PR.
Universidade Federal de Santa Catarina. Departamento de Farmacologia. Florianópolis, SC, Brasil.
Fundação Oswaldo Cruz. Instituto Carlos Chagas. Curitiba, PR, Brasil.
Universidade Federal do Paraná. Hospital das Clínicas. Departamento de Medicina Interna. Curitiba, PR, Brasil.
Universidade Federal do Paraná. Hospital das Clínicas. Unidade de Terapia Intensiva. Curitiba, PR.
Universidade Federal do Paraná. Hospital das Clínicas. Unidade de Terapia Intensiva. Curitiba, PR.
Universidade Federal do Paraná. Hospital das Clínicas. Unidade de Terapia Intensiva. Curitiba, PR.
Universidade Federal de Santa Catarina. Departamento de Farmacologia. Florianópolis, SC, Brasil.
Fundação Oswaldo Cruz. Instituto Carlos Chagas. Curitiba, PR, Brasil.
Universidade Federal do Paraná. Hospital das Clínicas. Departamento de Medicina Interna. Curitiba, PR, Brasil.
Abstract
To measure the prognostic value of peripheral ischemic microvascular reserve in the context of persistent sepsis-induced hyperlactatemia and measure its influence on the temporal dynamics of lactate and the strength of association between these variables. Methods: This post hoc analysis of the peripheral perfusion index/postocclusive reactive hyperemia trial, an observational cohort study that enrolled patients with sepsis who persisted with lactate levels ≥ 2mmol/L after fluid resuscitation (with or without shock). Peripheral ischemic microvascular reserve was evaluated using the association of the peripheral perfusion index and postocclusive reactive hyperemia techniques. The cut off point of ∆ peripheral perfusion index peak values (%) defined the groups with low (≤ 62%) and high peripheral ischemic microvascular reserve (> 62%). Results: A total of 108 consecutive patients with persistent sepsis-induced hyperlactatemia were studied. The high peripheral ischemic microvascular reserve group showed higher 28-day mortality. than the low peripheral ischemic microvascular reserve group (p < 0.01). The temporal dynamics of lactate within the first 48 hours showed a rapid decrease in lactate levels in the low peripheral ischemic microvascular reserve group (p < 0.01). However, this result was not reproduced in the linear mixed effects model. A weak correlation between peripheral ischemic microvascular reserve (%) and lactate level (mmol/L) was observed within the first 24 hours (r = 0.23; p < 0.05). Conclusion: The prognostic value of high peripheral ischemic microvascular reserve was confirmed in the context of persistent sepsis-induced hyperlactatemia. Although there was a weak positive correlation between peripheral ischemic microvascular reserve value and lactate level within the first 24 hours of sepsis diagnosis, the low peripheral ischemic microvascular reserve group appeared to have a faster decrease in lactate over the 48 hours of follow-up.
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