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  • Open Access

Tissue microdialysis in critically ill septic patients: associations with sepsis severity and mortality

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Critical Care201014 (Suppl 1) :P148

https://doi.org/10.1186/cc8380

  • Published:

Keywords

  • Pyruvate
  • Septic Shock
  • Sepsis Severity
  • Septic Patient
  • Study Entry

Introduction

In vivo microdialysis (MD) is a bedside sampling method that permits continuous analysis of a patient's extracellular tissue chemistry without consuming blood. MD is performed by implanting a commercially available catheter that mimics a blood capillary at the site of interest.

Methods

A total of 35 (20 men) mechanically ventilated septic patients having a median age of 60 years were studied. All patients met the ACCP/SCCM consensus criteria for sepsis. Upon sepsis onset, a microdialysis catheter (CMA 60; CMA, Solna, Sweden) was inserted into the subcutaneous adipose tissue of the upper thigh. The dialysate samples were collected in microvials and were analyzed immediately for glucose, pyruvate, lactate, and glycerol using a mobile CMA ISCUS analyzer. The lactate/pyruvate (L/P) ratio was automatically calculated. Measurements were performed six times per day during the first 6 days from sepsis onset. The daily mean values of MD measurements were calculated for each patient.

Results

Sepsis severity of the study group was graded as follows: sepsis (n = 5), severe sepsis (n = 2) and septic shock (n = 28). APACHE and SOFA scores at study entry were 23 ± 4 and 8 ± 3, respectively. Overall, 18 patients died yielding an ICU mortality rate of 51%. MD revealed that at study entry patients with septic shock had higher lactate (3.5 ± 1.6 vs 1.8 ± 0.9, P = 0.01), and higher pyruvate (204 ± 137 vs 95 ± 68, P = 0.04) levels compared with septic patients without shock. In contrast, the two groups had similar values for glucose (5.9 ± 2.7 vs 4.3 ± 2.9, P = 0.18), glycerol (369 ± 225 vs 252 ± 171, P = 0.21), and L/P ratio (83 ± 289 vs 75 ± 150, P = 0.92). Septic shock correlated with SOFA on day 1 (r = 0.55, P = 0.001), APACHE II (r = 0.42, P = 0.01), lactate on day 1 (r = 0.48, P = 0.004), lactate on day 2 (r = 0.50, P = 0.002), pyruvate on day 1 (r = 0.040, P = 0.018), and with pyruvate on day 2 (r = 0.35, P = 0.04). Nonsurvivors had higher glycerol (426 ± 236 vs 253 ± 157, P = 0.01) at study entry and on day 1 (437 ± 260 vs 282 ± 169, P = 0.04) compared with survivors. Nonsurvivors also had higher pyruvate levels on day 1 (170 ± 99 vs 104 ± 65, P = 0.03) and on day 2 (150 ± 81 vs 97 ± 61, P = 0.04). Logistic regression analysis showed that APACHE II (OR = 1.312, P = 0.06) and glycerol on day 1 (OR = 1.005, P = 0.04) independently predicted patient outcome.

Conclusions

MD seems to be a safe and promising tool in grading sepsis severity and in predicting early mortality in critically ill patients.

Authors’ Affiliations

(1)
Attikon University Hospital, Athens, Greece
(2)
Athens Veterans Hospital, Athens, Greece
(3)
Department of Therapeutics, Alexandra General Hospital, Athens, Greece

Copyright

© BioMed Central Ltd. 2010

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