Serum vascular endothelial growth factor affects tissue fluid accumulation and is associated with deteriorating tissue perfusion and oxygenation in severe sepsis: a prospective observational study

Chin Kuo Lin, Ying Huang Tsai, Kuo Chin Kao, Chieh Mo Lin, Shao Kui Zhou, Meng Chin Ho, Shu Yi Huang, Yu Hung Fang, Che Chia Chang, Wei Chun Lee, Yueh Lin Lee, Min Chi Chen, Meng Jer Hsieh, Yu Ching Lin, Ming Szu Hung, Wen Chun Kuo, Bor Shyh Lin*

*Corresponding author for this work

Research output: Contribution to journalJournal Article peer-review

2 Scopus citations

Abstract

BACKGROUND: Positive fluid balance and tissue fluid accumulation are associated with adverse outcomes in sepsis. Vascular endothelial growth factor (VEGF) increases in sepsis, promotes vascular permeability, and may affect tissue fluid accumulation and oxygenation. We used near-infrared spectroscopy (NIRS) to estimate tissue hemoglobin (Hb) oxygenation and water (H 2O) levels to investigate their relationship with serum VEGF levels.

MATERIAL AND METHODS: New-onset severe sepsis patients admitted to the intensive care unit were enrolled. Relative tissue concentrations of oxy-Hb ([HbO 2]), deoxy-Hb ([HbR]), total Hb ([HbT]), and H 2O ([H 2O]) were estimated by near-infrared spectroscopy (NIRS) for three consecutive days and serum VEGF levels were measured. Comparisons between oliguric and non-oliguric patients were conducted and the correlations between variables were analyzed.

RESULTS: Among 75 eligible patients, compared with non-oliguric patients, oliguric patients were administrated more intravascular fluids (median [IQR], 1926.00 [1348.50-3092.00] mL/day vs. 1069.00 [722.00-1486.75] mL/day, p < 0.001) and had more positive daily net intake and output (mean [SD], 1,235.06 [1303.14] mL/day vs. 313.17 [744.75] mL/day, p = 0.012), lower [HbO 2] and [HbT] over the three-day measurement (analyzed by GEE p = 0.01 and 0.043, respectively) and significantly higher [H 2O] on the third day than on the first two days (analyzed by GEE p = 0.034 and 0.018, respectively). Overall, serum VEGF levels were significantly negatively correlated with [HbO 2] and [HbT] (rho = - 0.246 and - 0.266, p = 0.042 and 0.027, respectively) but positively correlated with [H 2O] (rho = 0.449, p < 0.001). Subgroup analysis revealed a significant correlation between serum VEGF and [H2O] in oliguric patients (rho = 0.532, p = 0.003). Multiple regression analysis determined the independent effect of serum VEGF on [H 2O] (standardized coefficient = 0.281, p = 0.038).

CONCLUSIONS: In severe sepsis, oliguria relates to higher positive fluid balance, lower tissue perfusion and oxygenation, and progressive tissue fluid accumulation. Elevated serum VEGF is associated with worsening tissue perfusion and oxygenation and independently affects tissue fluid accumulation.

Original languageEnglish
Article number155
Pages (from-to)155
JournalEuropean Journal of Medical Research
Volume28
Issue number1
DOIs
StatePublished - 21 04 2023

Bibliographical note

© 2023. The Author(s).

Keywords

  • Microcirculation
  • Near-infrared spectroscopy
  • Sepsis
  • Tissue fluid
  • Vascular endothelial growth factor
  • Prospective Studies
  • Reperfusion
  • Sepsis/metabolism
  • Humans
  • Hemoglobins/metabolism
  • Vascular Endothelial Growth Factor A/blood

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