Endothelial-Dependent Responses Correlate with Pediatric SOFA Scores During Severe Sepsis and Septic Shock

Abstract

Sepsis is an exaggerated host response to an infectious challenge that is associated with significant alterations in vasomotor tone. We hypothesized that the endothelial dysfunction observed during severe sepsis and septic shock would correlate with the degree of organ failure as determined by the pediatric Sequential Organ Failure Assessment (pSOFA) score. Utilizing laser Doppler perfusion monitoring coupled with iontophoresis, we found that endothelium-dependent vascular reactivity to acetylcholine (ACh) stimulation significantly correlated with both total pSOFA scores and, more specifically, cardiovascular (CV) pSOFA scores. Alternatively, endothelium-independent vascular reactivity using sodium nitroprusside (SNP) did not demonstrate a significant relationship with pSOFA scores. These data suggest that endothelial-mediated vasculopathy may be a key driver of organ dysfunction during episodes of pediatric sepsis.

Keywords: Endothelial; Pediatrics; Sepsis; Vascular reactivity.

Fig 1.

a) Representative LDPMI tracing for 2 different patients on day 1. Arrowheads indicate start of iontophoresis pulses. Linear and non-linear regression plots (solid lines) with 95% confidence intervals (dashed lines) for ACh and SNP versus matched b) pSOFA on 1 day of admission and c) pSOFA or d) CV pSOFA scores in aggregate of all measurements over hospitalization with associated R-squared values and Spearman correlation p values.