Low systemic vascular resistance: differential diagnosis and outcome

Melo, Jairo; Peters, Jay I.

doi:10.1186/cc343

Cited by 20 publications

(9 citation statements)

References 43 publications

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“…Septic shock is the most severe infectious complication in bloodstream infections. Early recognition and successful management of septic shock remain numerous knowledge gaps and challenges, because SAP patients without infections may mimic septic shock [ 30 ]. Patients with septic shock should be timely received antibiotic treatments, because there is a definite guideline to start anti-sepsis shock therapy as early as possible [ 31 ].…”

Section: Discussionmentioning

confidence: 99%

Predictors of mortality in acute pancreatitis complicated with multidrug-resistant Klebsiella pneumoniae infection

Ding

Jia

et al. 2021

BMC Infect Dis

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Background Multidrug-resistant (MDR) Klebsiella pneumoniae infections, from pancreatic infections to bloodstream infections, influence the mortality of patients with acute pancreatitis (AP) on the condition of limited antibiotic choices. The aim of this study was to investigate the predictor of mortality among AP patients complicated with MDR-K. pneumoniae infections. Methods Seventy-one AP patients who occurred MDR-K. pneumoniae infections from August 1st, 2016 to August 1st, 2020 were enrolled. MDR-K. pneumoniae was defined as the K. pneumoniae strain non-susceptible to at least one agent in three or more antimicrobial categories. MDR-K. pneumoniae isolates were confirmed by Vitek-2 system. Antibiotic susceptibility test was carried out using a micro broth dilution method. Clinical characteristics and drug-resistance rates were retrospectively reviewed, and the predictors of mortality were evaluated by univariate and multivariate analyses. Results The mortality rate of AP patients complicated with MDR-K. pneumoniae infections reached 46.5% (33 of 71), and pancreas (n = 53) was the most common site of MDR-K pneumoniae strains. The drug resistance rates of MDR-K. pneumoniae were high to 11 of 12 common antibiotics (more than 50.0%) except of tigecycline (23.9%). The predictor independently associated with mortality was septic shock (hazard ratio 2.959, 95% confidence intervals 1.396 – 6.272, P = 0.005). Conclusions More attention should be paid for pancreatic MDR-K. pneumoniae infections among AP patients The predictor for mortality of AP patients complicated with MDR-K. pneumoniae infection is septic shock. Therefore, further clinical investigations should focus on areas against septic shock.

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Section: Discussionmentioning

confidence: 99%

Predictors of mortality in acute pancreatitis complicated with multidrug-resistant Klebsiella pneumoniae infection

Ding

Jia

et al. 2021

BMC Infect Dis

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“…Injured endothelial cells result in arginine-vasopressin system dysfunction, which results in increased secretions of tumor necrosis factor, prostacyclin, lipopolysaccharide, reactive oxidants, interleukin-1, circulating endothelin, and nitric oxide, which reduce peripheral vascular resistance and vascular reactivity to vasoconstrictors, causing refractory hypotension [ 18 , 19 ]. Previous adult studies have demonstrated that a low SVRI caused by an impaired endothelium is a predictor of mortality in septic patients [ 20 , 21 ]; however, the clinical application of SVRI has not been well established in children with septic shock.…”

Section: Discussionmentioning

confidence: 99%

“…In our study, we used vasoactive-inotropic agents to achieve the target level of 3.3-6.0 L/min/m 2 , and we found that serial SVRI values were significantly lower in the mortality group compared with the survival group. In addition, in the mortality group, despite a gradual increase in SVRI, the prolonged duration of low SVRI meant a longer period of tissue hypoperfusion, indicating more organ damage [ 20 ]. Therefore, lower serial SVRI values can be used as an earlier marker of disease severity and insufficient resuscitation.…”

Section: Discussionmentioning

confidence: 99%

Comparison of Predictive Powers for Mortality between Systemic Vascular Resistance Index and Serum Lactate in Children with Persistent Catecholamine-Resistant Shock

Lee

Chu

Hsia

et al. 2020

BioMed Research International

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Persistent catecholamine-resistant shock in children causes severe morbidity and mortality. We aimed to analyze the association between hemodynamics and serum lactate at different time points and 28-day mortality in children with persistent catecholamine-resistant shock. Methods. Twenty-six children with persistent catecholamine-resistant shock were enrolled, and their hemodynamics were monitored using the pulse index continuous cardiac output. Serial cardiac index (CI), systemic vascular resistant index (SVRI), and vasoactive-inotropic score (VIS) were analyzed for the first 24 hours. Associations between hemodynamics, serum lactate, and 28-day mortality were analyzed. Results. The 28-day mortality rate was 53.8%. SVRI and VIS were independent predictors of 28-day mortality. The mortality group had lower serial SVRI and higher VIS than the survival group (p<0.05). Serial SVRI had the highest area under the receiver operating characteristic curve (AUC) for predicting mortality during the first 24 hours of persistent catecholamine-resistant shock. Three important hemodynamic parameters, CI, SVRI and perfusion pressure (MAP-CVP), were significantly correlated with lactate, of which SVRI had the best correlation (r=−0.711, p<0.001). According to the AUC, SVRI was a more powerful predictor of mortality than lactate in persistent catecholamine-resistant shock. After 24 hours of treatment for persistent catecholamine-resistant shock, an SVRI lower than 1284 dyn·s·cm-5·m2 was associated with 28-day mortality. Conclusions. SVRI was an early factor associated with mortality in the pediatric patients with persistent catecholamine-resistant shock potentially and had the good correlation with serum lactate. An SVRI more than 1284 dyn·s·cm-5·m2 during the first 24 hours of persistent catecholamine-resistant shock was associated with favorable outcomes. The result should be used with caution due to the small sample size.

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“…Injured endothelial cells indicate dysfunction of the arginine-vasopressin system, which may increase the secretion of tumor necrosis factor, lipopolysaccharides, interleukin-1, circulating endothelin, and nitric oxide, and decrease systemic vascular resistance, causing vascular hyporesponsiveness to vasoactive agents, thereby resulting in refractory hypotension [19]. Previous reports have shown that lower SVRI is associated with mortality in adults with septic shock [20,21]; however, the clinical utilization of SVRI has not been well surveyed in pediatric septic shock. Our previous study with the same group reported that SVRI was a predictor for in-hospital mortality in pediatric septic shock [22].…”

Section: Discussionmentioning

confidence: 99%

“…Therefore, early higher levels of SVRI may indicate better outcomes. In the mortality group, although the SVRI increased gradually, the prolonged period of a low SVRI indicated a longer duration of tissue hypoperfusion, representing more organ damage [20]. Moreover, lower serial SVRI may allow the early recognition of disease severity and insufficient treatment and prompt the immediate titration of vasoactive-inotropic agents to raise the SVRI.…”

Section: Discussionmentioning

confidence: 99%

Cutoff Values of Hemodynamic Parameters in Pediatric Refractory Septic Shock

et al. 2022

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Background: Refractory septic shock can cause severe morbidities and mortalities in children. Resuscitation based on hemodynamics is important in children with critical illness. Thus, this study aimed to identify the hemodynamics of refractory septic shock associated with poor prognosis at an early stage to allow for timely interventions. Methods: We evaluated children with refractory septic shock admitted to a pediatric intensive care unit (PICU) and monitored their hemodynamics using a pulse index continuous cardiac output (PiCCO) system. The serial cardiac index (CI), systemic vascular resistance index (SVRI), and vasoactive–inotropic score (VIS) were recorded during the first 72 h after PICU admission. Results: Thirty-three children with refractory septic shock were enrolled. The SVRI and VIS were both associated with fatality from septic shock. The non-survivors had lower serial SVRI and higher VIS (both p < 0.05). Based on the area under the ROC curve, the SVRI was the predictor during the early resuscitative stage (first 36 h) in pediatric refractory septic shock. Conclusions: Both SVRI and VIS are predictors of mortality in children with refractory septic shock, and the SVRI is the powerful predictor of mortality in the early resuscitative stage. A low serial SVRI may allow for the early awareness of disease severity and strategies for adjusting vasoactive–inotropic agents to increase the SVRI.

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Low systemic vascular resistance: differential diagnosis and outcome

Cited by 20 publications

References 43 publications

Predictors of mortality in acute pancreatitis complicated with multidrug-resistant Klebsiella pneumoniae infection

Predictors of mortality in acute pancreatitis complicated with multidrug-resistant Klebsiella pneumoniae infection

Comparison of Predictive Powers for Mortality between Systemic Vascular Resistance Index and Serum Lactate in Children with Persistent Catecholamine-Resistant Shock

Cutoff Values of Hemodynamic Parameters in Pediatric Refractory Septic Shock

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