Affiliation:
1. The University of Queensland - Critical Care Research Group
2. Critical Care Research Group - The University of Queensland
3. The University of Queensland Faculty of Medicine
4. KEMRI-Wellcome Trust Research Programme, Kilifi and Imperial College London, UK
Abstract
Abstract
Introduction
Shock-induced endotheliopathy (SHINE), defined as a profound sympathoadrenal hyperactivation in shock states leading to endothelial activation, glycocalyx damage, and eventual compromise of end-organ perfusion, was first described in 2017. The aggressive resuscitation therapies utilised in treating shock states could potentially lead to further worsening endothelial activation and end-organ dysfunction.
Objective
This study aimed to systematically review the literature on resuscitation-associated and resuscitation-induced endothelial dysfunction.
Methods
A pre-determined structured search of literature published over an eleven-year period (1 January 2011 to 31 December 2022) was performed in two indexed databases (PubMed/MEDLINE and EMBASE) per PRISMA guidelines.
Results
Thirty studies met the inclusion criteria and were included in the final qualitative synthesis. Most of these studies (43%) reported on a combination of mediators released from endothelial cells and biomarkers of glycocalyx breakdown, while only 20% reported on microvascular flow changes. Only eight individual studies were included in the quantitative meta-analysis based on the comparability of the parameters assessed. Six studies measured syndecan-1, with a heterogeneity index, I2 = 75.87% (pooled effect-size; z = 2.00; mean = 0.43; 95% CI 0.01 to 0.85; p = 0.05). Thrombomodulin was measured in 4 comparable studies (I2 = 78.93%; z = 1.57; mean = 0.41; 95% CI -0.10 to 0.92; p = 0.12).
Conclusion
Acute resuscitation therapies administered could exacerbate endothelial dysfunction in shock states. In the included studies, syndecan-1 had the highest frequency of assessment in the post-resuscitation period and changes in concentrations showed a statistically significant effect of the resuscitation. There are inadequate data available in this area and further research and standardisation of the ideal assessment and panel of biomarkers are urgently needed.
Publisher
Research Square Platform LLC
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