The Value of Early Diastolic Transmitral Velocity to Early Mitral Anulus Diastolic Velocity Ratio for Pulmonary Edema in Severe Sepsis Patients

Objective To determine the predictive value of early changes in sublingual microcirculation on organ failure of patients with septic shock. Methods Side-streamdark field imaging (SDF) videomicroscopy was performed to assess sublingual microcirculation of 34 adult patients at 0 h, 6 h and 24 h after they were diagnosed with septic shock.The patients were subject to sequential organ failure assessment (SOFA_{24 h-0 h}). The patients with ΔSOFA_{24 h-0 h}≥1 (deteriorated conditions) were compared with those with ΔSOFA_{24 h-0 h}＜1 in regard to sublingual microcirculation and the traditional hemodynamic indicators such as heart rate, mean arterial pressure,central venous pressure,urine output and lactate. Results No significant baseline differences were found between the two groups of patients in age, sex and acute physiology and chronic health evaluation Ⅱ (APACHE Ⅱ), nor any differences in the traditional hemodynamic indicators, as well as dose of vasopressor, infusion of crystalloids, and colloids after septic shock was diagnosed. The patients with deteriorated conditions had lower proportion of perfused small vessels (PPVs) compared with the non-deteriorated patients at 0 h 〔(75.96±10.55)% vs.（84.03±10.16）%, P=0.032〕 and 24 h 〔（79.43±9.23）% vs.（86.32±9.02）%， P=0.037〕. The ROC analysis showed a greater area under the curve (AUC) for PPVs at 0 h 〔0.750 (95%CI,0.586-0.914)〕 compared with the AUC for Lac at 0 h 〔0.588 (95%CI，0.370-0.805) 〕, albeit a lack of statistical significance ( P>0.05). The incidence of organ failure in the patients with a lower than optimal cut-off point (81.5%) of PPVs was significantly higher than that of those above the cut-off point (71.4% vs. 20.0%）. Conclusion Changes in sublingual microcirculation (e.g. PPVs) can predict the development of organ failure earlier than systemic hemodynamic indicators in patients with septic shock.