[Effects of changes of endothelial function on prognosis in patients with severe sepsis]

To explore the changes of brachial flow-mediated vasodilation (FMD), vascular endothelial growth factor (VEGF) and soluble VEGF receptor 1 (sFLT) in patients with severe sepsis and evaluate their prognostic values.

A total of 128 patients with severe sepsis were consecutively recruited from January 2009 to January 2011 at Intensive Care Unit of Zhejiang Hospital. And their general profiles and clinical characteristics were analyzed. Brachial artery FMD was measured by ultrasound upon admission after a diagnosis of severe sepsis. The plasma levels of VEGF and sFLT were measured by enzyme-linked immunosorbent assay (ELISA).

The average age was (69.0 ± 10.1) years and the 28-day mortality rate stood at 41.4%. Compared with the survivors, the non-survivors had a lower brachial FMD (P < 0.001) and a higher plasma concentration of sFLT (P = 0.006). However, the survivors and non-survivors had a similar plasma level of sFLT (P = 0.32). In addition, brachial FMD was inversely correlated with sFLT (r = -0.39, P < 0.001), but not with plasma VEGF (r = 0.07, P = 0.11). Receiver operating characteristic (ROC) analysis showed that the optimal FMD (sensitivity 81%, specificity 76%) and plasma sFLT (sensitivity 77%, specificity 71%) cutoff values were 4.5% and 398 pg/ml for 28-day mortality respectively. The multiple Logistic regression analysis revealed that brachial FMD (OR = 0.48, 95%CI: 0.22 - 0.81, P = 0.04) and plasma sFLT (OR = 1.86, 95%CI: 1.21 - 3.08, P = 0.02) were independent predictors of 28-day mortality rate.

Lower brachial FMD and higher plasma sFLT may reflect endothelial function impairment and carry a higher risk of mortality in patients with severe sepsis and have. Non-invasive ultrasonic assessment of flow-mediated dilation is recommended.