title: Severe abnormalities in microvascular perfused vessel density are associated to organ dysfunctions and mortality and can be predicted by hyperlactatemia and norepinephrine requirements in septic shock patients.
abstract: OBJECTIVE
  The aims of this study are to determine the general relationship of perfused vessel density (PVD) to mortality and organ dysfunctions and to explore if patients in the lowest quartile of distribution for this parameter present a higher risk of bad outcome and to identify systemic hemodynamic and perfusion variables that enhances the probability of finding a severe underlying microvascular dysfunction.
  
  
  METHODS
  This is a retrospective multicenter study including 122 septic shock patients participating in 7 prospective clinical trials on which at least 1 sublingual microcirculatory assessment was performed during early resuscitation.
  
  
  RESULTS
  Perfused vessel density was significantly related to organ dysfunctions and mortality, but this effect was largely explained by patients in the lowest quartile of distribution for PVD (P = .037 [odds ratio {OR}, 8.7; 95% confidence interval {CI}, 1.14-66.78] for mortality). Hyperlactatemia (P < .026 [OR, 1.23; 95% CI, 1.03-1.47]) and high norepinephrine requirements (P < .019 [OR, 7.04; 95% CI, 1.38-35.89]) increased the odds of finding a severe microvascular dysfunction.
  
  
  CONCLUSIONS
  Perfused vessel density is significantly related to organ dysfunctions and mortality in septic shock patients, particularly in patients exhibiting more severe abnormalities as represented by the lowest quartile of distribution for this parameter. The presence of hyperlactatemia and high norepinephrine requirements increases the odds of finding a severe underlying microvascular dysfunction during a sublingual microcirculatory assessment.
authors.affiliation: Department of Translational Physiology, Academic Medical Center, University of Amsterdam, Meibergdreef 9, 1105 AZ Amsterdam, The Netherlands. glennguru@gmail.com
authors.forename: Glenn
authors.initials: G
authors.lastname: Hernandez
authors.forename: E Christiaan
authors.initials: EC
authors.lastname: Boerma
authors.forename: Arnaldo
authors.initials: A
authors.lastname: Dubin
authors.forename: Alejandro
authors.initials: A
authors.lastname: Bruhn
authors.forename: Matty
authors.initials: M
authors.lastname: Koopmans
authors.forename: Vanina Kanoore
authors.initials: VK
authors.lastname: Edul
authors.forename: Carolina
authors.initials: C
authors.lastname: Ruiz
authors.forename: Ricardo
authors.initials: R
authors.lastname: Castro
authors.forename: Mario Omar
authors.initials: MO
authors.lastname: Pozo
authors.forename: Cesar
authors.initials: C
authors.lastname: Pedreros
authors.forename: Enrique
authors.initials: E
authors.lastname: Veas
authors.forename: Andrea
authors.initials: A
authors.lastname: Fuentealba
authors.forename: Eduardo
authors.initials: E
authors.lastname: Kattan
authors.forename: Maximiliano
authors.initials: M
authors.lastname: Rovegno
authors.forename: Can
authors.initials: C
authors.lastname: Ince
mesh_terms: D018806:APACHE; D000293:Adolescent; D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D001118:Argentina; D016009:Chi-Square Distribution; D002677:Chile; D003430:Cross-Sectional Studies; D005260:Female; D006439:Hemodynamics / Q000502:physiology; D006801:Humans; D007773:Lactates / Q000097:blood*; D016015:Logistic Models; D008297:Male; D008833:Microcirculation / Q000187:drug effects / Q000502:physiology; D008875:Middle Aged; D009060:Mouth Floor / Q000098:blood supply*; D009426:Netherlands; D009638:Norepinephrine / Q000627:therapeutic use; D011237:Predictive Value of Tests; D012189:Retrospective Studies; D012772:Shock, Septic / Q000097:blood / Q000503:physiopathology* / Q000628:therapy*; D018709:Statistics, Nonparametric; D014662:Vasoconstrictor Agents / Q000627:therapeutic use
chemical_list: D007773:Lactates; D014662:Vasoconstrictor Agents; D009638:Norepinephrine
keywords: Lactate; Microcirculation; Mixed venous oxygen saturation; Norepinephrine; Perfusion; Septic shock