Thesis (Ph.D.) - Cairo University - Faculty of Medicine - Department of Critical Care Medicine

Methods: An observational prospective controlled study of patients admitted in the Critical Care Department at Cairo University Egypt. Patients were classified into two groups GROUP I which included 38 pateints : Sepsis (2 patients); Severe sepsis (20 patients) who had sepsis and target organ damage and Septic shock (16 patients) who had severe sepsis and developed inadequate tissue perfusion. Control group: GROUP II includes 10 critically ill patients who did not develop sepsis in their hospital clinical course. HBP Blood samples were collected at three time points during six days after admission. We measured brachial artery reactivity in 38 severe sepsis patients and in 10 control patients acute illness other than sepsis, Measurements were compared in severe sepsis patients versus control subjects and in survivors versus non-survivors. Multivariable analyses were also conducted.Results: Significant difference was detected between Survivors and Non-survivors in max SOFA score, Baseline WBCs, WBCs at 48 and 96 h as well as Baseline HBP, HBP at 48h and 96 h, where the result were in non-survivors versus survivors respectively{5.9(4.8-6.6)}ng/ml vs {1.2(0.4-1.6)}ng/ml at baseline; { 6.5(4.8-7.5)}ng/ml vs {1.2(1.2-1.7)}ng/ml at 48 hours and lastly {6.0(4.5-6.6)}ng/ml vs {1.12(0.8-1.4)} ng/ml at 96 hours . (ROC) curve analysis for prediction of severe sepsis, septic shock using Baseline HBP, AUC:0.982 , P < 0.0001 with sensitivity 94.7% specificity 100%, cut-off level >1.9 ng/ml, (ROC) curve analysis for prediction of mortality using Baseline HBP level, (AUC) =0.99, P-value< 0.0001, Sensitivity 91.6%, Specificity 100%, associated criterion >1.9 ng/ml. Highly significant difference exists between survivors and Non-survivors respectively in FMD, Baseline velocity, Hyperemic velocity, Velocity difference and Post-deflation RI. The results were in non-survivors versus survivors respectively for FMD% {2.3(1.9-2.8)} % vs {5.5(4.7-5.8)} %. Baseline velocity cm/cardiac cycle 12(9.7-14.3)} vs {20(17.6-22)}

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