背景:脓毒性休克患者微循环异常与器官功能障碍和死亡率密切相关。据推测,动脉血糖和间质液(ISF)葡萄糖差(GA-I)作为评估微循环状态的指标可以有效评估感染性休克患者微循环障碍的严重程度。
方法:本观察性研究纳入了在三级教学医院的重症监护病房(ICU)接受治疗的感染性休克患者。反映器官和组织灌注的参数,包括乳酸(Lac),皮肤斑点评分,毛细血管再充盈时间(CRT),静脉-动脉二氧化碳差(Pv-aCO2),尿量,在入选时(H0)记录每位入选患者的中心静脉血氧饱和度(ScvO2)和GA-I,H2、H4、H6和H8。以ICU死亡率为主要结果指标,分析了任何GA-I间期的ICU死亡率.
结果:共纳入43例脓毒性休克患者,中位序贯器官衰竭评估(SOFA)评分为10.5(6-16),和中位急性生理学和慢性健康评估(APACHAE)II评分为25.7(9-40),其中18人在ICU住院期间死亡。GA-I水平与CRT呈负相关(r=0.369,P<0.001),Lac(r=-0.269,P<0.001),皮肤斑点评分(r=-0.223,P<0.001),与尿量呈正相关(r=0.135,P<0.05)。出现GA-I≤0.30mmol/L和≥2.14mmol/L的感染性休克患者的ICU死亡率明显高于出现GA-I患者0.30-2.14mmol/L的患者[65.2%vs.15.0%,优势比(OR)=10.625,95%置信区间(CI):2.355-47.503]。
结论:GA-I与微循环参数相关,和生存的差异。需要进一步研究GA-I对感染性休克微循环和临床预后的潜在影响。和GA-I的床旁监测可能有利于临床医生识别高危患者。
BACKGROUND: Microcirculation abnormality in septic shock is closely associated with organ dysfunction and mortality rate. It was hypothesized that the arterial blood glucose and interstitial fluid (ISF) glucose difference (GA-I) as a marker for assessing the microcirculation status can effectively evaluate the severity of microcirculation disturbance in patients with septic shock.
METHODS: The present observational study enrolled patients with septic shock admitted to and treated in the intensive care unit (ICU) of a tertiary teaching hospital. The parameters reflecting organ and tissue perfusion, including lactic acid (Lac), skin mottling score, capillary refill time (CRT), venous-to-arterial carbon dioxide difference (Pv-aCO2), urine volume, central venous oxygen saturation (ScvO2) and GA-I of each enrolled patient were recorded at the time of enrollment (H0), H2, H4, H6, and H8. With ICU mortality as the primary outcome measure, the ICU mortality rate at any GA-I interval was analyzed.
RESULTS: A total of 43 septic shock patients were included, with median sequential organ failure assessment (SOFA) scores of 10.5 (6-16), and median Acute Physiology and Chronic Health Evaluation (APACHAE) II scores of 25.7 (9-40), of whom 18 died during ICU stay. The GA-I levels were negative correlation with CRT (r = 0.369, P < 0.001), Lac (r = -0.269, P < 0.001), skin mottling score (r=-0.223, P < 0.001), and were positively associated with urine volume (r = 0.135, P < 0.05). The ICU mortality rate of patients with septic shock presenting GA-I ≤ 0.30 mmol/L and ≥ 2.14 mmol/L was significantly higher than that of patients with GA-I at 0.30-2.14 mmol/L [65.2% vs. 15.0%, odds ratio (OR) = 10.625, 95% confidence interval (CI): 2.355-47.503].
CONCLUSIONS: GA-I was correlated with microcirculation parameters, and with differences in survival. Future studies are needed to further explore the potential impact of GA-I on microcirculation and clinical prognosis of septic shock, and the bedside monitoring of GA-I may be beneficial for clinicians to identify high-risk patients.