Impaired endothelium-dependent vasodilatation is a novel predictor of mortality in intensive care.
OBJECTIVE
Endothelial function may be impaired in critical illness. We hypothesized that impaired endothelium-dependent vasodilatation is a predictor of mortality in critically ill patients.


METHODS
Prospective observational cohort study.


METHODS
Seventeen-bed adult intensive care unit in a tertiary referral university teaching hospital.


METHODS
Patients were recruited within 24 hrs of admission to the intensive care unit.


METHODS
The SphygmoCor Mx system was used to derive the aortic augmentation index from radial artery pulse pressure waveforms. Endothelium-dependent vasodilatation was calculated as the change in augmentation index in response to an endothelium-dependent vasodilator (salbutamol).


RESULTS
Demographics, severity of illness scores, and physiological parameters were collected. Statistically significant predictors of mortality identified using single regressor analysis were entered into a multiple logistic regression model. Receiver operator characteristic curves were generated. Ninety-four patients completed the study. There were 80 survivors and 14 nonsurvivors. The Simplified Acute Physiology Score II, the Sequential Organ Failure Assessment score, leukocyte count, and endothelium-dependent vasodilatation conferred an increased risk of mortality. In logistic regression analysis, endothelium-dependent vasodilatation was the only predictor of mortality with an adjusted odds ratio of 26.1 (95% confidence interval [CI], 4.3-159.5). An endothelium-dependent vasodilatation value of 0.5% or less predicted intensive care unit mortality with a sensitivity of 79% (CI, 59-88%) and specificity of 98% (CI, 94-99%).


CONCLUSIONS
In vivo bedside assessment of endothelium-dependent vasodilatation is an independent predictor of mortality in the critically ill. We have shown it to be superior to other validated severity of illness scores with high sensitivity and specificity.
Regional Intensive Care Unit, Royal Victoria Hospital, Belfast, UK.
Martin J
MJ
Duffy
Brian A
BA
Mullan
Thelma R
TR
Craig
Murali
M
Shyamsundar
Rob E
RE
MacSweeney
Gillian
G
Thompson
Michael
M
Stevenson
Daniel F
DF
McAuley
D000368:Aged; D000420:Albuterol / Q000097:blood; D016001:Confidence Intervals; D004730:Endothelium, Vascular / Q000503:physiopathology*; D005260:Female; D017052:Hospital Mortality; D006801:Humans; D007362:Intensive Care Units / Q000706:statistics & numerical data*; D016015:Logistic Models; D008297:Male; D008875:Middle Aged; D016017:Odds Ratio; D011237:Predictive Value of Tests; D011446:Prospective Studies; D012372:ROC Curve; D012307:Risk Factors; D012680:Sensitivity and Specificity; D018805:Sepsis / Q000097:blood / Q000401:mortality; D012720:Severity of Illness Index; D014664:Vasodilation / Q000502:physiology
D000420:Albuterol