title: Alteration of the sublingual microvascular glycocalyx in critically ill patients.
abstract: Glycocalyx degradation may contribute to microvascular dysfunction and tissue hypoperfusion during systemic inflammation and sepsis. In this observational study we evaluated the alteration of the sublingual microvascular glycocalyx in 16 healthy volunteers and 50 critically ill patients. Sidestream Dark Field images of the sublingual microcirculation were automatically analyzed by dedicated software. The Perfused Boundary Region (PBR) was calculated as the dimensions of the permeable part of the glycocalyx allowing the penetration of circulating red blood cells, providing an index of glycocalyx damage. The PBR was increased in ICU patients compared to healthy controls (2.7 [2.59-2.88] vs. 2.46 [2.37-2.59]μm, p<0.0001) and tended to be higher in the 32 septic patients compared to non-septics (2.77 [2.62-2.93] vs. 2.67 [2.55-2.75]μm, p=0.05), suggesting more severe glycocalyx alterations. A PBR of 2.76 showed the best discriminative ability towards the presence of sepsis (sensitivity: 50%, specificity: 83%; area under the receiver operating characteristic curve: 0.67, 95% CI 0.52-0.82, p=0.05). A weak positive correlation was found between PBR and heart rate (r=0.3, p=0.03). In 17 septic patients, a correlation was found between PBR and number of rolling leukocytes in post-capillary venules (RL/venule) (r=0.55, p=0.02), confirming that glycocalyx shedding enhances leukocyte-endothelium interaction.
authors.affiliation: Anesthesia and Intensive Care Unit, Department of Medical Biosciences and Public Health, Università Politecnica delle Marche, via Conca 71, 60126 Ancona, Italy; Department of Translational Physiology, Academic Medical Center, University of Amsterdam, Meibergdreef 9, 1105 AZ Amsterdam, The Netherlands. Electronic address: a.donati@univpm.it.
authors.forename: Abele
authors.initials: A
authors.lastname: Donati
authors.forename: Elisa
authors.initials: E
authors.lastname: Damiani
authors.forename: Roberta
authors.initials: R
authors.lastname: Domizi
authors.forename: Rocco
authors.initials: R
authors.lastname: Romano
authors.forename: Erica
authors.initials: E
authors.lastname: Adrario
authors.forename: Paolo
authors.initials: P
authors.lastname: Pelaia
authors.forename: Can
authors.initials: C
authors.lastname: Ince
authors.forename: Mervyn
authors.initials: M
authors.lastname: Singer
mesh_terms: D000368:Aged; D019540:Area Under Curve; D001783:Blood Flow Velocity; D016022:Case-Control Studies; D016638:Critical Illness; D042783:Endothelial Cells / Q000473:pathology*; D005260:Female; D019276:Glycocalyx / Q000473:pathology*; D006339:Heart Rate; D006801:Humans; D007090:Image Interpretation, Computer-Assisted; D007362:Intensive Care Units; D036904:Leukocyte Rolling; D008297:Male; D008833:Microcirculation; D018715:Microscopy, Video; D055806:Microvessels / Q000473:pathology* / Q000503:physiopathology; D008875:Middle Aged; D019095:Point-of-Care Systems; D011237:Predictive Value of Tests; D012372:ROC Curve; D018805:Sepsis / Q000473:pathology* / Q000503:physiopathology; D012984:Software; D013997:Time Factors; D014059:Tongue / Q000098:blood supply*
keywords: APACHE II; Acute Physiology and Chronic Health Evaluation II; HR; ICU; Intensive Care Unit; PBR; Perfused Boundary Region; RL; ROC curve; SDF; Sidestream Dark Field; heart rate; not significant; ns; receiver operating characteristic curve; rolling leukocytes