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Relationship between peripheral ischemic microvascular reserve, persistent hyperlactatemia, and its temporal dynamics
Ana Carolina de Miranda1, Fernanda do Carmo De Stefani2, Bruna Cassia Dal Vesco2
1Department of Internal Medicine, Hospital de Clínicas, Universidade Federal do Paraná - Curitiba (PR), Brazil.
Critical Care Science
|September 15, 2023
Summary
High peripheral ischemic microvascular reserve indicates worse prognosis in persistent sepsis-induced hyperlactatemia. Patients with low reserve showed faster lactate level decreases, suggesting potential therapeutic implications.
Area of Science:
- Critical Care Medicine
- Hemodynamics
- Sepsis Pathophysiology
Background:
- Persistent sepsis-induced hyperlactatemia is a marker of poor prognosis.
- Microvascular dysfunction plays a key role in sepsis pathophysiology.
- Assessing microvascular reserve may offer prognostic insights.
Purpose of the Study:
- To evaluate the prognostic significance of peripheral ischemic microvascular reserve in patients with persistent sepsis-induced hyperlactatemia.
- To determine the association between microvascular reserve and lactate level dynamics.
- To explore the relationship between microvascular reserve and mortality.
Main Methods:
- Post hoc analysis of an observational cohort study.
- Evaluation of peripheral ischemic microvascular reserve using peripheral perfusion index and postocclusive reactive hyperemia.
- Group stratification based on peripheral ischemic microvascular reserve (low ≤ 62% vs. high > 62%).
Main Results:
- Higher 28-day mortality was observed in the high peripheral ischemic microvascular reserve group (p < 0.01).
- The low peripheral ischemic microvascular reserve group exhibited a rapid decrease in lactate levels within 48 hours (p < 0.01).
- A weak positive correlation (r = 0.23; p < 0.05) was found between microvascular reserve and lactate levels within 24 hours.
Conclusions:
- High peripheral ischemic microvascular reserve is a significant negative prognostic indicator in persistent sepsis-induced hyperlactatemia.
- Lower microvascular reserve may be associated with a more favorable lactate clearance trajectory.
- These findings highlight the prognostic value of microvascular reserve assessment in sepsis management.
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