Impaired endothelium-dependent vasodilatation is a novel predictor of mortality in intensive care

• Published in: Critical care medicine Vol. 39; no. 4; pp. 629 - 635
• Main Authors: Duffy, Martin J, Mullan, Brian A, Craig, Thelma R, Shyamsundar, Murali, MacSweeney, Rob E, Thompson, Gillian, Stevenson, Michael, McAuley, Daniel F
• Format: Journal Article
• Language: English
• Published: Hagerstown, MD by the Society of Critical Care Medicine and Lippincott Williams & Wilkins 01-04-2011; Lippincott Williams & Wilkins
• Subjects: Aged; Albuterol - blood; Anesthesia. Intensive care medicine. Transfusions. Cell therapy and gene therapy; Biological and medical sciences; Clinical death. Palliative care. Organ gift and preservation; Confidence Intervals; Endothelium, Vascular - physiopathology; Female; Hospital Mortality; Humans; Intensive care medicine; Intensive Care Units - statistics & numerical data; Logistic Models; Male; Medical sciences; Middle Aged; Odds Ratio; Predictive Value of Tests; Prospective Studies; Risk Factors; ROC Curve; Sensitivity and Specificity; Sepsis - blood; Sepsis - mortality; Severity of Illness Index; Vasodilation - physiology; endothelial function; Intensive care; endothelium-dependent vasodilatation; Mortality; pulse wave analysis; ICU mortality; Resuscitation; Endothelium
• ISSN: 0090-3493; 1530-0293
• DOI: 10.1097/CCM.0b013e318206bc4a

OBJECTIVE:Endothelial function may be impaired in critical illness. We hypothesized that impaired endothelium-dependent vasodilatation is a predictor of mortality in critically ill patients.
DESIGN:Prospective observational cohort study.
SETTING:Seventeen-bed adult intensive care unit in a tertiary referral university teaching hospital.
PATIENTS:Patients were recruited within 24 hrs of admission to the intensive care unit.
INTERVENTIONS:The SphygmoCor Mx system was used to derive the aortic augmentation index from radial artery pulse pressure waveforms. Endothelium-dependent vasodilatation was calculated as the change in augmentation index in response to an endothelium-dependent vasodilator (salbutamol).
MEASUREMENTS AND MAIN RESULTS:Demographics, severity of illness scores, and physiological parameters were collected. Statistically significant predictors of mortality identified using single regressor analysis were entered into a multiple logistic regression model. Receiver operator characteristic curves were generated. Ninety-four patients completed the study. There were 80 survivors and 14 nonsurvivors. The Simplified Acute Physiology Score II, the Sequential Organ Failure Assessment score, leukocyte count, and endothelium-dependent vasodilatation conferred an increased risk of mortality. In logistic regression analysis, endothelium-dependent vasodilatation was the only predictor of mortality with an adjusted odds ratio of 26.1 (95% confidence interval [CI], 4.3–159.5). An endothelium-dependent vasodilatation value of 0.5% or less predicted intensive care unit mortality with a sensitivity of 79% (CI, 59–88%) and specificity of 98% (CI, 94–99%).
CONCLUSIONS:In vivo bedside assessment of endothelium-dependent vasodilatation is an independent predictor of mortality in the critically ill. We have shown it to be superior to other validated severity of illness scores with high sensitivity and specificity.