Relationship between ventricular arterial coupling and haemodynamics in patients with sepsis and its predictive value for prognosis

doi:10.11958/20242154

Abstract

Abstract:

Objective To investigate the relationship between ventricular arterial coupling (VAC) and haemodynamics of patients with sepsis and the predictive value for the 28-day prognosis. Methods A total of 164 patients with sepsis were selected and given fluid resuscitation treatment (infusion of 30 mL/kg of crystalloid over 3 h), and changes of VAC[effective aortic elasticity (Ea)/ventricular end-systolic elasticity (Ees)]values and hemodynamic parameters of patients resuscitated for 0 h, 24 h and 72 h were observed. The difference between Ea/Ees for 24 h and 72 h of resuscitation and 0 h was calculated. Pearson method was used to analyze the correlation between Ea/Ees and Δcentral venous pressure (CVP), Δspiratory volume index (SVI) and Δcardiac index (CI). According to the 28-day prognosis, patients were divided into two groups: the survival group (123 cases) and the death group (41 cases). General information was collected in two groups of patients. The predictive values of 24 h ΔEa/Ees and 72 h ΔEa/Ees for 28-day death in sepsis patients were analyzed by multivariate Cox regression models and receiver operating characteristics (ROC) curve. Results The Ea/Ees of 164 patients resuscitated for 24 h and 72 h were lower than those of 0 h, and the Ea/Ees of 72 h was lower than that of 24 h (all P<0.05). CVP, SVI and CI of 164 patients resuscitated for 24 h and 72 h were higher than those of 0 h, and the CVP, SVI and CI of 24 h was higher than that of 72 h (all P< 0.05). The 24 h ΔEa/Ees was significantly lower than that of 72 h ΔEa/Ees (P<0.05), and 24 h ΔCVP, SVI and CI were higher than those of 72 h (P<0.05). There was a negative correlation between 24 h ΔEa/Ees and 24 h ΔCVP, 24 h ΔSVI and 24 h ΔCI (P<0.05). Acute Physiology and Chronic Health Status Score II (APACHE II) ≥20 points, Sequential Organ Failure Score (SOFA)≥10 points, 24 h ΔEa/Ees and 72 h ΔEa/Ees were higher in the death group than those in the survival group (P<0.05). Elevated APACHE II, SOFA, 24 h ΔEa/Ees and 72 h ΔEa/Ees were risk factors affecting the 28-day prognosis of patients with sepsis (P<0.05). The 24-hour ΔEa/Ees and 72-hour ΔEa/Ees were more effective in predicting the 28 d prognosis of patients with sepsis (P<0.05). Conclusion Changes of Ea/Ees can better reflect the haemodynamic changes in sepsis patients in the early stages of treatment and help to predict the 28-day prognosis of sepsis patients.

Key words: sepsis, hemodynamics, prognosis, ventricular arterial coupling

CLC Number:

R631

Figures/Tables 7

References 20

[1]	赵奕琳, 刘田恬, 王春霞. 外泌体参与脓毒症发生发展及临床诊治方面的研究进展[J]. 中华危重病急救医学, 2024, 36(2):221-224.
	ZHAO Y L, LIU T T, WANG C X. Research advances in exosomes involved in the occurrence,development and clinical diagnosis and treatment of sepsis[J]. Chin Crit Care Med, 2024, 36(2):221-224. doi:10.3760/cma.j.cn121430-20230809-00601.
[2]	FORD V J, APPLEFELD W N, WANG J, et al. Cardiac magnetic resonance studies in a large animal model that simulates the cardiac abnormalities of human septic shock[J]. J Am Heart Assoc, 2024, 13(15):e034026. doi:10.1161/JAHA.123.034026.
[3]	王小燕, 朱雪峰, 陆赵阳, 等. 超声二维斑点追踪成像技术对尿毒症患者心室动脉偶联情况的评估价值[J]. 天津医药, 2021, 49(11):1203-1206.
	WANG X Y, ZHU X F, LU Z Y, et al. The predictive value of two-dimensional ultrasonic speckle tracking imaging technology for ventricular arterial coupling in uremic patients[J]. Tianjin Med J, 2021, 49(11):1203-1206. doi:10.11958/20203570.
[4]	欧阳秋芳, 游涛, 许荣, 等. 健心颗粒通过调控Apelin通路对心力衰竭大鼠心室-动脉偶联的影响[J]. 中成药, 2024, 46(1):262-267.
	OUYANG Q F, YOU T, XU R, et al. Effect of heart-healthy granules on ventricular-arterial coupling in heart failure rats through modulation of the Apelin pathway[J]. Chinese Traditional Patent Medicine, 2024, 46(1):262-267. doi:10.3969/j.issn.1001-1528.2024.01.045.
[5]	ZHOU X, PAN J, WANG Y, et al. Left ventricular-arterial coupling as a predictor of stroke volume response to norepinephrine in septic shock - a prospective cohort study[J]. BMC Anesthesiol, 2021, 21(1):56. doi:10.1186/s12871-021-01276-y.
[6]	DEMAILLY Z, BESNIER E, TAMION F, et al. Ventriculo-arterial (un)coupling in septic shock:impact of current and upcoming hemodynamic drugs[J]. Front Cardiovasc Med, 2023,10:1172703. doi:10.3389/fcvm.2023.1172703.
[7]	中国医师协会急诊医师分会, 中国研究型医院学会休克与脓毒症专业委员会. 中国脓毒症/脓毒性休克急诊治疗指南(2018)[J]. 中国急救医学, 2018, 38(9):741-756.
	Emergency Physicians Branch of Chinese Physicians Association,Shock and Sepsis Committee of Chinese Society of Research Hospitals. Chinese guidelines for emergency treatment of sepsis/septic shock (2018)[J]. Chin J Crit Care Meb, 2018, 38(9):741-756. doi:10.3969/j.issn.1002-1949.2018.09.001.
[8]	RANJIT S, KISSOON N, ARGENT A, et al. Haemodynamic support for paediatric septic shock:a global perspective[J]. Lancet Child Adolesc Health, 2023, 7(8):588-598. doi:10.1016/S2352-4642(23)00103-7.
[9]	LIAN H, LI S, ZHANG Q, et al. U-shaped prognostic value of left ventricular-arterial coupling in septic patients:a prospective study[J]. Eur J Med Res, 2024, 29(1):435. doi:10.1186/s40001-024-02037-6.
[10]	黄玉慧, 张岩, 范春芝, 等. 肾动脉阻力指数联合肺动脉高压对脓毒症患者死亡风险的预测价值[J]. 军事医学, 2024, 48(3):225-229.
	HUANG Y H, ZHANG Y, FAN C Z, et al. Renal resistive index combined with pulmonary hypertension in assessing mortality risk in sepsis patients[J]. Mil Med Sei, 2024, 48(3):225-229. doi:10.7644/j.issn.1674-9960.2024.03.010.
[11]	黄浩, 陈湘平, 李程锦, 等. 革兰阴性杆菌感染脓毒症患者B型利钠肽水平与血流动力学参数及炎性因子的相关性[J]. 中国医学科学院学报, 2021, 43(6):879-885.
	HUANG H, CHEN X P, LI C J, et al. Correlation of B-type natriuretic peptide level with hemodynamic parameters and inflammatory cytokines in patients with gram-negative sepsis[J]. Acta Academiae Medicinae Sinicae, 2021, 43(6):879-885. doi:10.3881/j.issn.1000-503X.14022.
[12]	董倩倩, 杨燕, 刘德智. 血流动力学参数与脓毒症休克患者容量反应性的预测及相关性分析[J]. 医用生物力学, 2023, 38(6):1219-1225.
	DONG Q Q, YANG Y, LIU D Z. Prediction and correlation analysis of hemodynamic parameters and volume responsiveness in patients with septic shock[J]. Journal of Medical Biomechanics, 2023, 38(6):1219-1225. doi:10.16156/j.1004-7220.2023.06.025.
[13]	NASU M, SATO R, TAKAHASHI K, et al. The chronological demographics of ventricular-arterial decoupling in patients with sepsis and septic shock:a prospective observational study[J]. J Intensive Care Med, 2023, 38(4):340-348. doi:10.1177/08850666221120219.
[14]	YOU J Y, SATO R, CHAWLA S, et al. Hemodynamic profile of cirrhotic patients with sepsis and septic shock:a propensity score matched case-control study[J]. J Crit Care, 2024,81:154532. doi:10.1016/j.jcrc.2024.154532.
[15]	MESSINA A, CALABRÒ L, PUGLIESE L, et al. Fluid challenge in critically ill patients receiving haemodynamic monitoring:a systematic review and comparison of two decades[J]. Crit Care, 2022, 26(1):186. doi:10.1186/s13054-022-04056-3.
[16]	ZHOU X, ZHANG Y, PAN J, et al. Optimizing left ventricular-arterial coupling during the initial resuscitation in septic shock - a pilot prospective randomized study[J]. BMC Anesthesiol, 2022, 22(1):31. doi:10.1186/s12871-021-01553-w.
[17]	KATTAN E, BAKKER J, ESTENSSORO E, et al. Hemodynamic phenotype-based,capillary refill time-targeted resuscitation in early septic shock:the ANDROMEDA-SHOCK-2 Randomized Clinical Trial study protocol[J]. Rev Bras Ter Intensiva, 2022, 34(1):96-106. doi:10.5935/0103-507X.20220004-pt.
[18]	MA Q, DING C, WEI W, et al. The value of right ventricular pulmonary artery coupling in determining the prognosis of patients with sepsis[J]. Sci Rep, 2024, 14(1):15283. doi:10.1038/s41598-024-65738-2.
[19]	QIU X, LEI Y P, ZHOU R X. SIRS,SOFA,qSOFA,and NEWS in the diagnosis of sepsis and prediction of adverse outcomes:a systematic review and meta-analysis[J]. Expert Rev Anti Infect Ther, 2023, 21(8):891-900. doi:10.1080/14787210.2023.2237192.
[20]	BOWCOCK E M, GERHARDY B, HUANG S, et al. Right ventricular outflow tract Doppler flow analysis and pulmonary arterial coupling by transthoracic echocardiography in sepsis:a retrospective exploratory study[J]. Crit Care, 2022, 26(1):303. doi:10.1186/s13054-022-04160-4.

时间	Ea/Ees	CVP/mmHg	SVI/mL	CI/[L/（min·m²）]
0 h	1.25±0.12	4.16±1.73	23.19±3.21	4.58±1.12
24 h	1.21±0.14^a	6.21±1.75^a	27.89±3.32^a	5.26±1.15^a
72 h	1.16±0.16^ab	5.53±1.73^ab	26.37±3.27^ab	4.93±1.12^ab
F_主效应	16.785^＊＊	59.285^＊＊	88.385^＊＊	14.849^＊＊

时间	Ea/Ees	CVP/mmHg	SVI/mL	CI/[L/（min·m²）]
0 h	1.25±0.12	4.16±1.73	23.19±3.21	4.58±1.12
24 h	1.21±0.14^a	6.21±1.75^a	27.89±3.32^a	5.26±1.15^a
72 h	1.16±0.16^ab	5.53±1.73^ab	26.37±3.27^ab	4.93±1.12^ab
F_主效应	16.785^＊＊	59.285^＊＊	88.385^＊＊	14.849^＊＊

时间	ΔEa/Ees	ΔCVP/ mmHg	ΔSVI/ mL	ΔCI/[L/ （min·m²）]
24 h	-0.08（-0.11，0.03）	2.05±0.23	4.70±0.84	0.67±0.17
72 h	-0.11（-0.15，0.02）	1.37±0.20	3.17±0.68	0.35±0.08
Z或t	7.024^＊＊	16.912^＊＊	10.560^＊＊	11.614^＊＊

时间	ΔEa/Ees	ΔCVP/ mmHg	ΔSVI/ mL	ΔCI/[L/ （min·m²）]
24 h	-0.08（-0.11，0.03）	2.05±0.23	4.70±0.84	0.67±0.17
72 h	-0.11（-0.15，0.02）	1.37±0.20	3.17±0.68	0.35±0.08
Z或t	7.024^＊＊	16.912^＊＊	10.560^＊＊	11.614^＊＊

指标	24 hΔEa/Ees	指标	72 hΔEa/Ees
24 hΔCVP	-0.654^＊＊	72 hΔCVP	-0.046
24 hΔSVI	-0.567^＊＊	72 hΔSVI	-0.082
24 hΔCI	-0.451^＊＊	72 hΔCI	-0.073