Changes in plasma free fatty acid levels in septic patients are associated with cardiac damage and reduction in heart rate variability

被引:64
作者
Nogueira, Antonio Carlos [2 ]
Kawabata, Victor [2 ]
Biselli, Paolo [2 ]
Lins, Marcelo Henrique [2 ]
Valeri, Carla [2 ]
Seckler, Mauricio [2 ]
Hoshino, Wagner [2 ]
Junior, Luiz Gonzaga [2 ]
Silveira Bernik, Marcia Martins [2 ]
de Andrade Machado, Juliana B. [2 ]
Martinez, Marina Baquerizo [2 ]
Lotufo, Paulo Andrade [2 ]
Caldini, Elia Garcia [3 ]
Martins, Edgair [4 ]
Curi, Rui [4 ]
Soriano, Francisco Garcia [1 ]
机构
[1] Univ Sao Paulo, Fac Med, Clin Emergency Discipline, FMUSP, BR-01246903 Sao Paulo, SP, Brazil
[2] Univ Sao Paulo, Sao Paulo Univ Hosp, Sao Paulo, Brazil
[3] Univ Sao Paulo, Dept Pathol, FMUSP, Sao Paulo, Brazil
[4] Univ Sao Paulo, Inst Biomed Sci, Sao Paulo, Brazil
来源
SHOCK | 2008年 / 29卷 / 03期
关键词
shock; sepsis; inflammation; cytokines; glucose;
D O I
10.1097/SHK.0b013e31815abbc6
中图分类号
R4 [临床医学];
学科分类号
1002 ; 100602 ;
摘要
Free fatty acids (FFAs) have been shown to produce alteration of heart rate variability (HRV) in healthy and diabetic individuals. Changes in HRV have been described in septic patients and in those with hyperglycemia and elevated plasma FFA levels. We studied if sepsis-induced heart damage and HRV alteration are associated with plasma FFA levels in patients. Thirty-one patients with sepsis were included. The patients were divided into two groups: survivors(n = 12) and nonsurvivors (n = 19). The following associations were investigated: (a) troponin I elevation and HRV reduction and (b) clinical evolution and HRV index, plasma troponin, and plasma FFA levels. Initial measurements of C-reactive protein and gravity Acute Physiology and Chronic Health Evaluation scores were similar in both groups. Overall, an increase in plasma troponin level was related to increased mortality risk. From the first day of study, the nonsurvivor group presented a reduced left ventricular stroke work systolic index and a reduced low frequency (LF) that is one of HRV indexes. The correlation coefficient for LF values and troponin was r(2) = 0.75 (P < 0.05). All patients presented elevated plasma FFA levels on the first day of the study (5.11 +/- 0.53 mg/mL), and this elevation was even greater in the nonsurvivor group compared with the survivors (6.88 +/- 0.13 vs. 3.85 +/- 0.48 mg/mL, respectively; P < 0.05). Cardiac damage was confirmed by measurement of plasma troponin I and histological analysis. Heart dysfunction was determined by left ventricular stroke work systolic index and HRV index in nonsurvivor patients. A relationship was found between plasma FFA levels, LFnu index, troponin levels, and histological changes. Plasma FFA levels emerged as possible cause of heart damage in sepsis.
引用
收藏
页码:342 / 348
页数:7
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