title: Endothelial dysfunction assessed by brachial artery ultrasound in severe sepsis and septic shock.
abstract: OBJECTIVE
  Noninvasive evaluation of endothelial function may be accomplished by ultrasound assessment of flow-mediated vasodilation (FMD) of the brachial artery. This study aims to investigate the role of FMD analysis on intrahospital prognosis of patients with sepsis.
  
  
  METHODS
  Adult patients admitted to the intensive care unit with severe sepsis or septic shock were consecutively included. Brachial artery FMD was measured upon admission, after 24 and 72 hours. A group of apparently healthy subjects paired for sex and age was used as controls. Patients were followed up to discharge or death.
  
  
  RESULTS
  We studied 42 patients (mean age, 51 ± 19 years) with sepsis predominantly of abdominal or respiratory etiology (75%). Acute Physiology And Chronic Health Evaluation II risk score was 23 ± 7, and intrahospital mortality rate was 33%. Flow-mediated vasodilation in septic patients was significantly lower than in healthy controls (1.5 ± 7% vs 6 ± 4%, P < .001). Most of the nonsurvivors (86%) showed a decline in sequential FMD analyses, whereas only 43% of survivors showed a reduction of FMD (P = .01). In nonsurvivors, FMD was significantly lower 72 hours after sepsis onset (-3.3% ± 10% vs 5.2% ± 4%; P < .05; time-group interaction P value = .03).
  
  
  CONCLUSIONS
  Brachial FMD is altered in septic patients with hemodynamic instability, and its deterioration may be an early marker of unfavorable prognosis.
authors.affiliation: Post-Graduate Program in Health Sciences, Cardiology and Cardiovascular Sciences, Medical School from Rio Grande doSul Federal University, Alegre, Brasil. lqbecker@terra.com.br
authors.forename: Leandro
authors.initials: L
authors.lastname: Becker
authors.forename: Karen
authors.initials: K
authors.lastname: Prado
authors.forename: Murilo
authors.initials: M
authors.lastname: Foppa
authors.forename: Nidiane
authors.initials: N
authors.lastname: Martinelli
authors.forename: Cynthia
authors.initials: C
authors.lastname: Aguiar
authors.forename: Thiago
authors.initials: T
authors.lastname: Furian
authors.forename: Nadine
authors.initials: N
authors.lastname: Clausell
authors.forename: Luis Eduardo
authors.initials: LE
authors.lastname: Rohde
mesh_terms: D001916:Brachial Artery / Q000000981:diagnostic imaging*; D016022:Case-Control Studies; D004730:Endothelium, Vascular / Q000000981:diagnostic imaging*; D005260:Female; D006801:Humans; D008297:Male; D016555:Matched-Pair Analysis; D008875:Middle Aged; D011237:Predictive Value of Tests; D011446:Prospective Studies; D018805:Sepsis / Q000000981:diagnostic imaging*; D012772:Shock, Septic / Q000000981:diagnostic imaging; D016019:Survival Analysis; D014463:Ultrasonography; D014664:Vasodilation