Turcato Gianni, Zaboli Arian, Filippi Lucia, Cipriano Alessandro, Ferretto Paolo, Maggi Michael, Lucente Fabrizio, Marchetti Massimo, Ghiadoni Lorenzo, Wiedermann Christian J
Intermediate Care Unit, Department of Internal Medicine, Hospital Alto Vicentino (AULSS-7), 36014 Santorso, Italy.
Department Health Science, UniCamillus-Saint Camillus International University of Health Sciences, 00131 Rome, Italy.
Clin Pract. 2025 Jun 25;15(7):120. doi: 10.3390/clinpract15070120.
Sepsis remains a leading cause of mortality worldwide, and understanding endothelial damage is crucial for improving patient outcomes. Endothelial dysfunction in sepsis contributes to coagulopathy, increased capillary permeability, and vasoplegia, but the interplay between these processes remains underexplored. The study aims to evaluate the clinical relationship between those factors due to sepsis-induced endothelial damage. A prospective single-center study on 75 community-acquired septic patients admitted to an Intermediate Care Unit. The Sepsis-Induced Coagulopathy (SIC) score, serum albumin (as a surrogate for capillary leak), and Total Peripheral Resistance Index (TPRI) (as a surrogate for vasoplegia) were assessed. Structural Equation Modeling (SEM) explored the relationship between variables, hypothesizing a common latent factor (endothelial damage). Principal Component Analysis assessed the shared variance among variables. The mean SIC score was 3.4 (SD 1.3), with 44% of patients affected. TPRI and albumin had mean values of 1954 (SD 738) and 2.58 (SD 0.59), respectively, both negatively correlated with SIC: TPRI -0.263 ( = 0.023) and albumin -0.454 ( < 0.001). SEM showed SIC, albumin, and TPRI are associated with a latent factor (endothelial damage), explaining 68% of the variance (CFI = 1.000, RMSEA = 0.000). Albumin was inversely correlated ( = 0.004), and TPRI was significantly associated ( = 0.003). This pilot study suggests that coagulopathy, increased vascular permeability, and vasoplegia may be clinically interrelated manifestations of endothelial injury in sepsis. These findings support the feasibility of modeling a unified pathophysiological construct using accessible bedside data, potentially guiding future individualized approaches in sepsis management.
脓毒症仍然是全球范围内主要的死亡原因,了解内皮损伤对于改善患者预后至关重要。脓毒症中的内皮功能障碍会导致凝血病、毛细血管通透性增加和血管麻痹,但这些过程之间的相互作用仍未得到充分研究。该研究旨在评估脓毒症诱导的内皮损伤所致这些因素之间的临床关系。对75名入住中级护理病房的社区获得性脓毒症患者进行了一项前瞻性单中心研究。评估了脓毒症诱导的凝血病(SIC)评分、血清白蛋白(作为毛细血管渗漏的替代指标)和总外周阻力指数(TPRI)(作为血管麻痹的替代指标)。结构方程模型(SEM)探讨了变量之间的关系,假设存在一个共同的潜在因素(内皮损伤)。主成分分析评估了变量之间的共同方差。SIC评分的平均值为3.4(标准差1.3),44%的患者受到影响。TPRI和白蛋白的平均值分别为1954(标准差738)和2.58(标准差0.59),两者均与SIC呈负相关:TPRI为-0.263(P = 0.023),白蛋白为-0.454(P < 0.001)。SEM显示SIC、白蛋白和TPRI与一个潜在因素(内皮损伤)相关,解释了68%的方差(比较拟合指数CFI = 1.000,均方根误差近似值RMSEA = 0.000)。白蛋白呈负相关(P = 0.004),TPRI显著相关(P = 0.003)。这项初步研究表明,凝血病、血管通透性增加和血管麻痹可能是脓毒症中内皮损伤的临床相关表现。这些发现支持了使用可获取的床边数据构建统一病理生理结构模型的可行性,这可能为未来脓毒症管理中的个体化方法提供指导。