Ocular microvascular changes in patients with sepsis: a prospective observational study

Jurate Simkiene, Zivile Pranskuniene, Astra Vitkauskiene, Vidas Pilvinis, E Christiaan Boerma, Andrius Pranskunas, Jurate Simkiene, Zivile Pranskuniene, Astra Vitkauskiene, Vidas Pilvinis, E Christiaan Boerma, Andrius Pranskunas

Abstract

Background: The aim of the study was to detect differences in the conjunctival microcirculation between septic patients and healthy subjects and to evaluate the course of conjunctival and retinal microvasculature in survivors and non-survivors over a 24-h period of time.

Methods: This single-center prospective observational study was performed in mixed ICU in a tertiary teaching hospital. We included patients with sepsis or septic shock within the first 24 h after ICU admission. Conjunctival imaging, using an IDF video microscope, and retinal imaging, using portable digital fundus camera, as well as systemic hemodynamic measurements, were performed at three time points: at baseline, 6 h and 24 h. Baseline conjunctival microcirculatory parameters were compared with healthy controls.

Results: A total of 48 patients were included in the final assessment and analysis. Median APACHE II and SOFA scores were 16[12-21] and 10[7-12], respectively. Forty-four (92%) patients were in septic shock, 48 (100%) required mechanical ventilation. 19 (40%) patients were discharged alive from the intensive care unit. We found significant reductions in all microcirculatory parameters in the conjunctiva when comparing septic and healthy subjects. In addition, we observed a significant lower microvascular flow index (MFI) of small conjunctival vessels during all three time points in non-survivors compared with survivors. However, retinal arteriolar vessels were not different between survivors and non-survivors.

Conclusions: Conjunctival microvascular blood flow was altered in septic patients. In the 24-h observation period conjunctival small vessels had a significantly higher MFI, but no difference in retinal arteriolar diameter in survivors in comparison with non-survivors. Trial registration NCT04214743, https://www.clinicaltrials.gov. Date of registration: 31 December 2019 - Retrospectively registered, https://ichgcp.net/clinical-trials-registry/NCT04214743.

Keywords: Conjunctival microcirculation; Fundus imaging; IDF imaging; Retinal vessels; Sepsis.

Conflict of interest statement

The authors declare that they have no competing interests.

Figures

Fig. 1
Fig. 1
Images of ocular microvasculature at baseline in septic patient: a conjunctival microcirculation, b manually segmented retinal vascular networks of septic patient
Fig. 2
Fig. 2
Box plots demonstrating the time course of microcirculatory perfusion parameters in survivors and non-survivors: a microvascular flow index; b proportion of perfused vessels (PPV) of small vessels; c perfused vessels density (PVD) of small vessels; d total vessel density (TVD) of small vessels. *p < 0.05 between survivors and non-survivors; #p < 0.05 in comparison with baseline

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