Chalkias Athanasios, Papagiannakis Nikolaos, Saugel Bernd, Flick Moritz, Kolonia Konstantina, Angelopoulou Zacharoula, Ragias Dimitrios, Papaspyrou Dimitra, Bouzia Aikaterini, Ntalarizou Nicoletta, Stamoulis Konstantinos, Kyriakaki Aikaterini, Eugen-Olsen Jesper, Laou Eleni, Arnaoutoglou Eleni
Department of Anesthesiology, Faculty of Medicine, University of Thessaly, 41500 Larisa, Greece.
Outcomes Research Consortium, Cleveland, OH 44195, USA.
J Clin Med. 2022 Jun 10;11(12):3326. doi: 10.3390/jcm11123326.
It remains unknown whether chronic systemic inflammation is associated with impaired microvascular perfusion during surgery. We evaluated the association between the preoperative basal inflammatory state, measured by plasma soluble urokinase-type plasminogen activator receptor (suPAR) levels, and intraoperative sublingual microcirculatory variables in patients undergoing major non-cardiac surgery. Plasma suPAR levels were determined in 100 non-cardiac surgery patients using the suPARnostic® quick triage lateral flow assay. We assessed sublingual microcirculation before surgical incision and every 30 min during surgery using Sidestream Darkfield (SDF+) imaging and determined the De Backer score, the Consensus Proportion of Perfused Vessels (Consensus PPV), and the Consensus PPV (small). Elevated suPAR levels were associated with lower intraoperative De Backer score, Consensus PPV, and Consensus PPV (small). For each ng mL−1 increase in suPAR, De Backer score, Consensus PPV, and Consensus PPV (small) decreased by 0.7 mm−1, 2.5%, and 2.8%, respectively, compared to baseline. In contrast, CRP was not significantly correlated with De Backer score (r = −0.034, p = 0.36), Consensus PPV (r = −0.014, p = 0.72) or Consensus PPV Small (r = −0.037, p = 0.32). Postoperative De Backer score did not change significantly from baseline (5.95 ± 3.21 vs. 5.89 ± 3.36, p = 0.404), while postoperative Consensus PPV (83.49 ± 11.5 vs. 81.15 ± 11.8, p < 0.001) and Consensus PPV (small) (80.87 ± 13.4 vs. 78.72 ± 13, p < 0.001) decreased significantly from baseline. In conclusion, elevated preoperative suPAR levels were associated with intraoperative impairment of sublingual microvascular perfusion in patients undergoing elective major non-cardiac surgery.
慢性全身性炎症是否与手术期间微血管灌注受损相关尚不清楚。我们评估了术前基础炎症状态（通过血浆可溶性尿激酶型纤溶酶原激活剂受体（suPAR）水平测量）与接受非心脏大手术患者术中舌下微循环变量之间的关联。使用suPARnostic®快速分诊侧向流动分析法测定了100例非心脏手术患者的血浆suPAR水平。我们在手术切口前和手术期间每隔30分钟使用侧流暗视野（SDF+）成像评估舌下微循环，并确定德贝克尔评分、灌注血管共识比例（Consensus PPV）和小血管灌注血管共识比例（Consensus PPV（small））。suPAR水平升高与术中较低的德贝克尔评分、Consensus PPV和Consensus PPV（small）相关。与基线相比，suPAR每增加1 ng mL−1，德贝克尔评分、Consensus PPV和Consensus PPV（small）分别降低0.7 mm−1、2.5%和2.8%。相比之下，CRP与德贝克尔评分（r = -0.034，p = 0.36）、Consensus PPV（r = -0.014，p = 0.72）或Consensus PPV Small（r = -0.037，p = 0.32）无显著相关性。术后德贝克尔评分与基线相比无显著变化（5.95 ± 3.21 vs. 5.89 ± 3.36，p = 0.404），而术后Consensus PPV（83.49 ± 11.5 vs. 81.15 ± 11.8，p < 0.001）和Consensus PPV（small）（80.87 ± 13.4 vs. 78.72 ± 13，p < 0.001）较基线显著降低。总之，术前suPAR水平升高与接受择期非心脏大手术患者术中舌下微血管灌注受损相关。
