Marker Of Sepsis Severity Is Associated With The Variation In Cardio-Ankle Vascular Index (CAVI) During Sepsis Treatment
Received 24 August 2019
Accepted for publication 14 October 2019
Published 5 November 2019 Volume 2019:15 Pages 509—516
Checked for plagiarism Yes
Review by Single-blind
Peer reviewers approved by Dr Nicola Ludin
Peer reviewer comments 2
Editor who approved publication: Professor Daniel Duprez
Daiji Nagayama,1,* Haruki Imamura,2,* Kei Endo,3 Atsuhito Saiki,2 Yuta Sato,2 Takashi Yamaguchi,2 Yasuhiro Watanabe,2 Masahiro Ohira,2 Kohji Shirai,4 Ichiro Tatsuno2
1Nagayama Clinic, Tochigi, Japan; 2Center of Diabetes, Endocrinology and Metabolism, Toho University, Sakura Medical Center, Chiba, Japan; 3Endo Clinic, Chiba, Japan; 4Department of Internal Medicine, Mihama Hospital, Chiba, Japan
*These authors contributed equally to this work
Correspondence: Daiji Nagayama
Nagayama Clinic, 2-12-22, Tenjin-Cho, Oyama-City, Tochigi 323-0032, Japan
Introduction: The main pathophysiology of sepsis is considered to be circulation crisis with an imbalance of vasodilation and vasoconstriction mechanisms, which contributes to multiple organ failure. However, sepsis-induced hemodynamic changes have not been fully validated by novel arterial stiffness parameter. The aim of this study was to clarify the acute vascular alteration and hemodynamic change in sepsis using cardio-ankle-vascular index (CAVI).
Methods: Twenty-one Japanese patients (14 males and 7 females, age 62.8 ± 19.0 years) with sepsis were recruited. CAVI was measured before and 1-week after sepsis treatment.
Results: The leading underlying cause of sepsis was pyelonephritis, followed by pneumonia, lung abscess, hepatic abscess and cholecystitis. All subjects recovered from sepsis. Analysis of all subjects showed a significant increase in CAVI after 1-week treatment (7.9 ± 2.4 to 9.6 ± 1.8, P < 0.001), but no significant change in blood pressure (BP) was observed. Significant correlations were observed for all combinations among the change in CAVI, systolic BP and ln[procalcitonin (PCT)], respectively. Additionally, in subjects with PCT at presentation ≥2.0 ng/mL, the increase in CAVI after treatment was significantly greater compared to those with PCT < 2.0 ng/mL (2.4 ± 1.6 vs 1.1 ± 0.9, P = 0.037).
Discussion: CAVI may reflect sepsis-induced vascular alteration which is not indicated by BP change, and is associated with sepsis severity. These findings suggest the usefulness of CAVI in the management of circulatory failure in sepsis patients.
Keywords: SIRS, circulation crisis, procalcitonin, arterial stiffness
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