title: Retinal arterial blood flow and retinal changes in patients with sepsis: preliminary study using fluorescein angiography.
abstract: Although tissue perfusion is often decreased in patients with sepsis, the relationship between macrohemodynamics and microcirculatory blood flow is poorly understood. We hypothesized that alterations in retinal blood flow visualized by angiography may be related to macrohemodynamics, inflammatory mediators, and retinal microcirculatory changes.
  
  
  
  Retinal fluorescein angiography was performed twice during the first 5 days in the intensive care unit to observe retinal abnormalities in patients with sepsis. Retinal changes were documented by hyperfluorescence angiography; retinal blood flow was measured as retinal arterial filling time (RAFT); and intraocular pressure was determined. In the analyses, we used the RAFT measured from the eye with worse microvascular retinal changes. Blood samples for inflammation and cerebral biomarkers were collected, and macrohemodynamics were monitored. RAFT was categorized as prolonged if it was more than 8.3 seconds.
  
  
  
  Of 31 patients, 29 (93%) were in septic shock, 30 (97%) required mechanical ventilation, 22 (71%) developed delirium, and 16 (51.6%) had retinal angiopathies, 75% of which were bilateral. Patients with prolonged RAFT had a lower cardiac index before (2.1 L/kg/m2vs. 3.1 L/kg/m2, P = 0.042) and during angiography (2.1 L/kg/m2vs. 2.6 L/kg/m2, P = 0.039). They more frequently had retinal changes (81% vs. 20%, P = 0.001) and higher intraocular pressure (18 mmHg vs. 14 mmHg, P = 0.031). Patients with prolonged RAFT had lower C-reactive protein (139 mg/L vs. 254 mg/L, P = 0.011) and interleukin-6 (39 pg/ml vs. 101 pg/ml, P < 0.001) than those with shorter RAFT.
  
  
  
  Retinal angiopathic changes were more frequent and cardiac index was lower in patients with prolonged RAFT, whereas patients with shorter filling times had higher levels of inflammatory markers.
authors.affiliation: Division of Intensive Care Medicine, Research Group of Surgery, Anesthesiology and Intensive Care Medicine, Department of Anesthesiology, Oulu University Hospital, Medical Research Center Oulu, University of Oulu, Oulu, Finland. kristo.erikson@ppshp.fi.
authors.forename: Kristo
authors.identifier: 0000-0002-0826-1366
authors.initials: K
authors.lastname: Erikson
authors.affiliation: Division of Intensive Care Medicine, Research Group of Surgery, Anesthesiology and Intensive Care Medicine, Department of Anesthesiology, Oulu University Hospital, Medical Research Center Oulu, University of Oulu, Oulu, Finland.
authors.forename: Janne Henrik
authors.initials: JH
authors.lastname: Liisanantti
authors.affiliation: Department of Ophthalmology, Medical Research Center and PEDEGO Research Unit, University of Oulu and Oulu University Hospital, Oulu, Finland.
authors.forename: Nina
authors.initials: N
authors.lastname: Hautala
authors.affiliation: Division of Intensive Care Medicine, Research Group of Surgery, Anesthesiology and Intensive Care Medicine, Department of Anesthesiology, Oulu University Hospital, Medical Research Center Oulu, University of Oulu, Oulu, Finland.
authors.forename: Juha
authors.initials: J
authors.lastname: Koskenkari
authors.affiliation: Institute of Biomedicine and Biocenter of Oulu, University of Oulu, Oulu, Finland.|Medical Research Center Oulu and Oulu University Hospital, Oulu, Finland.
authors.forename: Remi
authors.initials: R
authors.lastname: Kamakura
authors.affiliation: Institute of Biomedicine and Biocenter of Oulu, University of Oulu, Oulu, Finland.|Medical Research Center Oulu and Oulu University Hospital, Oulu, Finland.|Department of Gastroenterology and Metabolism, Poznan University of Medical Sciences, Poznan, Poland.
authors.forename: Karl Heinz
authors.initials: KH
authors.lastname: Herzig
authors.affiliation: Department of Infection Control, Oulu University Hospital, Medical Research Center Oulu, University of Oulu, Oulu, Finland.
authors.forename: Hannu
authors.initials: H
authors.lastname: Syrjälä
authors.affiliation: Division of Intensive Care Medicine, Research Group of Surgery, Anesthesiology and Intensive Care Medicine, Department of Anesthesiology, Oulu University Hospital, Medical Research Center Oulu, University of Oulu, Oulu, Finland.
authors.forename: Tero Ilmari
authors.initials: TI
authors.lastname: Ala-Kokko
mesh_terms: D000368:Aged; D002097:C-Reactive Protein / Q000032:analysis; D016009:Chi-Square Distribution; D005260:Female; D005451:Fluorescein Angiography / Q000379:methods*; D006439:Hemodynamics / Q000502:physiology; D006801:Humans; D007362:Intensive Care Units / Q000458:organization & administration; D015850:Interleukin-6 / Q000032:analysis / Q000097:blood; D008297:Male; D008833:Microcirculation / Q000502:physiology; D008875:Middle Aged; D011446:Prospective Studies; D012039:Regional Blood Flow / Q000502:physiology*; D012160:Retina / Q000503:physiopathology*; D018805:Sepsis / Q000150:complications* / Q000503:physiopathology; D018709:Statistics, Nonparametric
chemical_list: C508600:IL6 protein, human; D015850:Interleukin-6; D002097:C-Reactive Protein
keywords: Retinal arterial blood flow; Retinal changes; Sepsis