The association between hypoalbuminemia and microcirculation, endothelium, and glycocalyx disorders in children with sepsis

Fernández‐Sarmiento, Jaime; Hernández‐Sarmiento, Ricardo; Salazar, María Paula; Barrera, Sofia; Castilla, Valeria; Duque, Catalina

doi:10.1111/micc.12829

Cited by 5 publications

(1 citation statement)

References 41 publications

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“…An increased PBR indicates a decreased glycocalyx thickness, and it has been related with a higher risk of adverse outcomes. In septic children, thicker PBR and lower capillary density have been associated with hypoalbuminemia [23 ▪▪ ,24 ▪▪ ]. Integrity and changes in the endothelial glycocalyx can also be evaluated using serum biomarkers (Syndecan-1, heparan sulfate or hyaluronan, among others) [23 ▪▪ ,24 ▪▪ ,25].…”

Section: Microcirculationmentioning

confidence: 99%

Resuscitating the macro- vs. microcirculation in septic shock

González,

Urbano,

López-Herce

2024

Current Opinion in Pediatrics

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Purpose of review This review summarizes current literature about the relationships between macro and microcirculation and their practical clinical implications in children with septic shock. Recent findings Current evidence from experimental and clinical observational studies in children and adults with septic shock reveals that the response to treatment and resuscitation is widely variable. Furthermore, there is a loss of hemodynamic coherence, as resuscitation-induced improvement in macrocirculation (systemic hemodynamic parameters) does not necessarily result in a parallel improvement in the microcirculation. Therefore, patient-tailored monitoring is essential in order to adjust treatment requirements during resuscitation in septic shock. Optimal monitoring must integrate macrocirculation (heart rate, blood pressure, cardiac output, and ultrasound images), microcirculation (videomicroscopy parameters and capillary refill time) and cellular metabolism (lactic acid, central venous blood oxygen saturation, and difference of central venous to arterial carbon dioxide partial pressure). Summary There is a dire need for high-quality studies to assess the relationships between macrocirculation, microcirculation and tissue metabolism in children with septic shock. The development of reliable and readily available microcirculation and tissue perfusion biomarkers (other than lactic acid) is also necessary to improve monitoring and treatment adjustment in such patients.

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Section: Microcirculationmentioning

confidence: 99%

Resuscitating the macro- vs. microcirculation in septic shock

González,

Urbano,

López-Herce

2024

Current Opinion in Pediatrics

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Association between the lactate-albumin ratio and microcirculation changes in Pediatric Septic patients

Pérez,

Fernández-Sarmiento,

Bustos

et al. 2024

Sci Rep

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A lactate/albumin ratio (LAR) greater than 0.5 measured early in the course of pediatric critical illness is associated with greater mortality. Whether the elevated LAR can be explained by microcirculation disorders in children with sepsis is not known. In this longitudinal retrospective study (January 2021-January 2024), serum albumin and lactate were measured on admission to the pediatric intensive care unit (PICU), with sublingual video microscopy performed simultaneously to measure microcirculation. A total of 178 children were included, 37% of whom had septic shock measured with the Phoenix Sepsis Score. Patients with remote sepsis had greater odds of an elevated LAR (aOR 6.87: 95% CI 1.98–23.73; p < 0.01). Children with an elevated LAR had more microvascular blood flow abnormalities (aOR 1.31 95% CI 1.08–1.58; p < 0.01), lower 4-6-micron capillary density (aOR 1.03 95% CI 1.01–1.05; p < 0.01) and greater odds of dying (aOR 3.55 95% CI 1.21–10.38; p = 0.02) compared to those with a low LAR. We found no association between LAR and endothelial glycocalyx degradation. A normal LAR is associated with less risk of microcirculatory injury (aOR 0.77 95% CI 0.65–0.93; p < 0.01). In children with sepsis, an elevated LAR is associated with microcirculation abnormalities (microvascular density and flow). The lactate/albumin ratio is a potentially useful biomarker for microcirculatory injury in sepsis. Supplementary Information The online version contains supplementary material available at 10.1038/s41598-024-73112-5.

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Significant Association of Serum Albumin With the Severity of Coronary Microvascular Dysfunction Using Dynamic CZT‐SPECT

Chien,

Wang,

Tsai

et al. 2024

Microcirculation

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ObjectiveBoth low serum albumin (SA) concentration and coronary microvascular dysfunction (CMD) are risk factors for the development of heart failure (HF). We hypothesized that SA concentration is associated with myocardial flow reserve (MFR) and implicated in pathophysiological mechanism of HF.MethodsWe retrospectively studied 454 patients undergoing dynamic cardiac cadmium‐zinc‐telluride myocardial perfusion imaging from April 2018 to February 2020. The population was categorized into three groups according to SA level (g/dL): Group 1: >4, Group 2: 3.5–4, and Group 3: <3.5. Myocardial blood flow (MBF) and myocardial flow reserve (MFR, defined as stress/rest MBF ratio) were compared.ResultsThe mean age of the whole cohort was 66.2 years, and 65.2% were men. As SA decreased, stress MBF (mL min−1 g−1) and MFR decreased (MBF: 3.29 ± 1.03, MFR: 3.46 ± 1.33 in Group 1, MBF: 2.95 ± 1.13, MFR: 2.51 ± 0.93 in Group 2, and MBF: 2.64 ± 1.16, MFR: 1.90 ± 0.50 in Group 3), whereas rest MBF (mL min−1 g−1) increased (MBF: 1.05 ± 0.42 in Group 1, 1.27 ± 0.56 in Group 2, and 1.41 ± 0.61 in Group 3). After adjusting for covariates, compared with Group 1, the odds ratios for impaired MFR (defined as MFR < 2.5) were 3.57 (95% CI: 2.32–5.48) for Group 2 and 34.9 (95% CI: 13.23–92.14) for Group 3. The results would be similar if only regional MFR were assessed. The risk prediction for CMD using SA was acceptable, with an AUC of 0.76.ConclusionLow SA concentration was associated with the severity of CMD in both global and regional MFR as well as MBF.

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The association between hypoalbuminemia and microcirculation, endothelium, and glycocalyx disorders in children with sepsis

Cited by 5 publications

References 41 publications

Resuscitating the macro- vs. microcirculation in septic shock

Resuscitating the macro- vs. microcirculation in septic shock

Association between the lactate-albumin ratio and microcirculation changes in Pediatric Septic patients

Significant Association of Serum Albumin With the Severity of Coronary Microvascular Dysfunction Using Dynamic CZT‐SPECT

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