Abstract

Purpose

To investigate the effect of IV fluid resuscitation on endothelial glycocalyx (EG) shedding and activation of the vascular endothelium and inflammation.

Materials and methods

A planned biomarker sub-study of the REFRESH trial in which emergency department (ED) patients) with suspected sepsis and hypotension were randomised to a restricted fluid/early vasopressor regimen or IV fluid resuscitation with later vasopressors if required (usual care). Blood samples were collected at randomisation (T0) and at 3 h (T3), 6 h (T6)- and 24 h (T24) for measurement of a range of biomarkers if EG shedding, endothelial cell activation and inflammation.

Results

Blood samples were obtained in 95 of 99 enrolled patients (46 usual care, 49 restricted fluid). Differences in the change in biomarker over time between the groups were observed for Hyaluronan (2.2-fold from T3 to T24, p = 0.03), SYN-4 (1.5-fold from T3 to T24, P = 0.01) and IL-6 (2.5-fold from T0 to T3, p = 0.03). No difference over time was observed between groups for the other biomarkers.

Conclusions

A consistent signal across a range of biomarkers of EG shedding or of endothelial activation or inflammation was not demonstrated. This could be explained by pre-existing EG shedding or overlap between the fluid volumes administered in the two groups in this clinical trial.

Trial registration Australia New Zealand Clinical Trials Registry ACTRN126160000006448 Registered 12 January 2016.

Details

Title
Effect of intravenous fluid volume on biomarkers of endothelial glycocalyx shedding and inflammation during initial resuscitation of sepsis
Author
Macdonald, Stephen 1   VIAFID ORCID Logo  ; Bosio, Erika 2 ; Keijzers, Gerben 3 ; Burrows, Sally 4 ; Hibbs, Moira 5 ; O’Donoghue, Helen 5 ; Taylor, David 6 ; Mukherjee, Ashes 7 ; Kinnear, Frances 8 ; Smart, Lisa 9 ; Ascencio-Lane, Juan-Carlos 10 ; Litton, Edward 11 ; Fraser, John 12 ; Shapiro, Nathan I. 13 ; Arendts, Glenn 14 ; Fatovich, Daniel 1 ; McCutcheon, David; Leonard, Anton; Burcham, Jonathan; Bellomo, Rinaldo; Harley, Amanda; Winearls, James; Ascencio-Lane, Juan Carlos; Brown, Simon; Cooper, David; Vlad, Ioana; Wibrow, Bradley; Anstey, Matthew; Hazelwood, Sarah

1  Harry Perkins Institute of Medical Research, Centre for Clinical Research in Emergency Medicine, Perth, Australia (GRID:grid.431595.f) (ISNI:0000 0004 0469 0045); University of Western Australia, Medical School, Perth, Australia (GRID:grid.1012.2) (ISNI:0000 0004 1936 7910); Royal Perth Hospital, Emergency Department, Perth, Australia (GRID:grid.416195.e) (ISNI:0000 0004 0453 3875) 
2  Harry Perkins Institute of Medical Research, Centre for Clinical Research in Emergency Medicine, Perth, Australia (GRID:grid.431595.f) (ISNI:0000 0004 0469 0045); University of Western Australia, Medical School, Perth, Australia (GRID:grid.1012.2) (ISNI:0000 0004 1936 7910) 
3  Gold Coast University Hospital, Emergency Department, Gold Coast, Australia (GRID:grid.413154.6) (ISNI:0000 0004 0625 9072); Bond University, Faculty of Health Sciences and Medicine, Gold Coast, Australia (GRID:grid.1033.1) (ISNI:0000 0004 0405 3820); Griffith University, School of Medicine, Gold Coast, Australia (GRID:grid.1022.1) (ISNI:0000 0004 0437 5432) 
4  University of Western Australia, Medical School, Perth, Australia (GRID:grid.1012.2) (ISNI:0000 0004 1936 7910); Research Foundation, Royal Perth Hospital, Perth, Australia (GRID:grid.416195.e) (ISNI:0000 0004 0453 3875) 
5  Royal Perth Hospital, Research Centre, Perth, Australia (GRID:grid.416195.e) (ISNI:0000 0004 0453 3875) 
6  Austin Health, Emergency Department, Melbourne, Australia (GRID:grid.410678.c) (ISNI:0000 0000 9374 3516) 
7  Armadale Health Service, Emergency Department, Perth, Australia (GRID:grid.410678.c) 
8  University of Queensland, Department of Medicine, Brisbane, Australia (GRID:grid.1003.2) (ISNI:0000 0000 9320 7537) 
9  Health Engineering and Education, Murdoch University, School of Science, Perth, Australia (GRID:grid.1025.6) (ISNI:0000 0004 0436 6763) 
10  Royal Hobart Hospital, Emergency Department, Hobart, Australia (GRID:grid.416131.0) (ISNI:0000 0000 9575 7348) 
11  Fiona Stanley Hospital, Intensive Care, Perth, Australia (GRID:grid.459958.c) (ISNI:0000 0004 4680 1997) 
12  The Prince Charles Hospital, University of Queensland, Critical Care Research Group, Brisbane, Australia (GRID:grid.459958.c) 
13  Beth Israel Deaconess Medical Center and Harvard Medical School, Department of Emergency Medicine, Boston, USA (GRID:grid.239395.7) (ISNI:0000 0000 9011 8547) 
14  Harry Perkins Institute of Medical Research, Centre for Clinical Research in Emergency Medicine, Perth, Australia (GRID:grid.431595.f) (ISNI:0000 0004 0469 0045); University of Western Australia, Medical School, Perth, Australia (GRID:grid.1012.2) (ISNI:0000 0004 1936 7910); Fiona Stanley Hospital, Emergency Department, Perth, Australia (GRID:grid.459958.c) (ISNI:0000 0004 4680 1997) 
Pages
21
Publication year
2023
Publication date
Dec 2023
Publisher
Springer Nature B.V.
e-ISSN
2197425X
Source type
Scholarly Journal
Language of publication
English
DOI
https://doi.org/10.1186/s40635-023-00508-4
ProQuest document ID
2801820306
Copyright
© The Author(s) 2023. This work is published under http://creativecommons.org/licenses/by/4.0/ (the “License”). Notwithstanding the ProQuest Terms and Conditions, you may use this content in accordance with the terms of the License.