title: [The clinical significance of determining the severity and prognosis by monitoring the changes in sublingual microcirculation in patients with severe sepsis].
abstract: OBJECTIVE
  To investigate the clinical significance of dynamic monitoring of changes in the sublingual microcirculation in patients with severe sepsis to determine the degree of severity of the clinical condition and prognosis.
  
  
  METHODS
  A prospective study was conducted. Sixty--five patients in the intensive care unit (ICU) in Beijing Friendship Hospital were enrolled from June 2010 to December 2010, among whom there were 30 cases of sepsis, 35 cases of severe sepsis. The severe sepsis patients received the early goal--directed resuscitation; and at 0 (before treatment), 6, 12, 24, 48, 72 hours after resuscitation, the technology of sidestream dark--field was used to measure the sublingual total vessel density (TVD), perfusing vessel density (PVD), proportion of perfused vessels (PPV), microvascular flow index (MFI) of sublingual microcirculation in patients and acute physiology and chronic health evaluation II (APACHEII) score, ICU days and 28--day mortality were recorded. Thirty healthy individuals were enrolled as the control group.
  
  
  RESULTS
  The sublingual PPV and MFI were significantly lower in sepsis patients than those of the control group [PPV: (73.60 ± 16.77)% vs. (85.17 ± 7.60)%; MFI: 3.23 ± 0.77 vs. 3.78 ± 0.35, both P < 0.05]; PVD, PPV, MFI in severe sepsis patients were not only significantly lower than those of the sepsis group {PVD[mm/mm²]: 7.53 ± 4.38 vs.12.15 ± 2.88; PPV: (49.13 ± 33.74)% vs. (73.60 ± 16.77)%; MFI: 2.21 ± 1.41 vs. 3.23 ± 0.77, all P < 0.05}. After the early goal--directed fluid resuscitation, the sublingual microcirculation was improved significantly compared with that before treatment (0 hour), and they were remarkably apparent at 12 hours {TVD[mm/mm²]: 5.76 ± 2.25 vs. 6.72 ± 4.37; PVD [mm/mm²]: 7.57 ± 1.77 vs. 5.48 ± 4.39; PPV:(69.47 ± 19.24)% vs. (34.55 ± 30.82)%; MFI: 3.17 ± 0.49 vs. 1.55 ± 1.14, all P < 0.05}. Compared with the sepsis group, APACHEII score of the severe sepsis group was elevated (24.77 ± 7.45 vs. 19.30 ± 10.36, but P>0.05), the length of stay in ICU (days) was longer (20.60 ± 19.87 vs. 10.33 ± 9.53, P < 0.05), and the 28--day mortality was higher (45.71% vs. 36.36%, but P>0.05). In the severe sepsis group, compared with the survival group (19 cases), the sublingual microcirculation in the non-survival group (16 cases) PVD, PPV, MFI were significantly decreased{PVD[mm/mm²]:6.70 ± 5.15 vs. 8.53 ± 3.13; PPV: (44.23 ± 37.71)% vs. (54.96 ± 28.41)%; MFI: 1.89 ± 1.65 vs. 2.58 ± 0.98, P < 0.05 or P < 0.01}, but APACHEII score and length of stay in ICU (days) were not significantly different (23.19 ± 6.46 vs. 20.31 ± 6.03; 16.13 ± 10.90 vs. 19.19 ± 9.90, both P > 0.05). Correlation analysis showed that: PPV showed a significant negative correlation with the prognosis of the patients (r = -0.374, P < 0.05).
  
  
  CONCLUSIONS
  Sequential monitoring of the sublingual microcirculation in patients with severe sepsis can be used to determine the disease severity, and to forecast the outcome of the patient.
authors.affiliation: Department of Intensive Care Unit, Beijing Friendship Hospital Affiliated to Capital Medical University, Beijing 100050, China.
authors.forename: Meng-ya
authors.initials: MY
authors.lastname: Zhao
authors.forename: Ang
authors.initials: A
authors.lastname: Li
authors.forename: Hai-zhou
authors.initials: HZ
authors.lastname: Zhuang
authors.forename: Lei
authors.initials: L
authors.lastname: Dong
authors.forename: Jian
authors.initials: J
authors.lastname: Li
authors.forename: Chong
authors.initials: C
authors.lastname: Liu
authors.forename: Yi-bing
authors.initials: YB
authors.lastname: Weng
authors.forename: Shu-wen
authors.initials: SW
authors.lastname: Zhang
authors.forename: Mei-li
authors.initials: ML
authors.lastname: Duan
mesh_terms: D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D016022:Case-Control Studies; D006801:Humans; D008833:Microcirculation; D008875:Middle Aged; D009060:Mouth Floor / Q000098:blood supply*; D011379:Prognosis; D011446:Prospective Studies; D018805:Sepsis / Q000175:diagnosis* / Q000473:pathology; D055815:Young Adult