The effect of conservative fluid management on Toll-like receptor 4 signal pathway of peripheral blood mononuclear cells and cardiac function in patients with septic shock / 中华传染病杂志

ABSTRACT

Objective To evaluate the effect of different fluid resuscitation strategies on the cardiac function in patients with septic shock.Methods Forty-eight patients met diagnostic criteria of septic shock were enrolled prospectively between January 2014 and April 2015.Patients were divided into conservative late fluid management (CLFM) group (n =20) and liberal late fluid management (LLFM) group (n=28) after achieving early goal-directed therapy within 24 h.Haemodynamic parameters,mRNA levels in Toll-like receptor 4 (TLR4) signal pathway and serum levels of myocardial damage markers were compared.Student t-test was used to compare means between two groups.Quantitative data that were not normally distributed were compared by Mann-Whitney U test.Qualitative data were compared using x2 test.Multivariable Logistic regression analysis was used to identify the independent predictors for prognosis.Results The cardiac function index (CFI) in CLFM group were (5.01± 1.41)/min and (5.39±1.48)/min on day 3 and day 7,respectively,and the cardiac index (CI) were (3.43±0.50) and (3.73±0.76) mL · min-1 · m-2 on day 3 and day 7,respectively.The CFI and CI in LLFM group were (4.28±1.22)/min,(4.22±1.63)/min and (3.31±1.24),(3.09±1.14) mL · min-1 · m-2 respectively on day 3 and day 7.The differences between two groups were statistically significant on day 7 (t=2.546,2.185,both P＜0.05).TheTLR4 mRNAlevelswere3.0±1.1 inCLFM group compared to 4.8±1.4in LLFM group on day 3 (t=4.786,P＜0.01) and 1.6±0.5 compared to 4.0±1.1 on day 7 (t=9.089,P＜0.01).Nuclear factor (NF)-κB mRNA levels were 3.5±1.1 inCLFM group compared to 6.8±1.5 in LLFM group on day 3 (t=8.354,P＜0.01) and 2.4±0.5 compared to 5.7±0.9 (t=14.820,P＜0.01) on day 7.The levels of serum tumor necrosis factor (TNF)-α and interleukin (IL)-1β in CLFM group were lower than those in LLFM group on day 3 and day 7 (all P＜0.01).Multivariable Logistic regression analysis showed that fluid balance (OR =1.236,95 ％ CI0.78-1.692,P =0.033),CFI (OR=3.263,95％CI1.136-7.936,P=0.027) and acute physiology and chronic health evaluation Ⅱ (OR=2.064,95％CI1.248-2.898,P=0.003) were the independent predictors for 28-day mortality.Conclusions CLFM may inhibit the product of myocardial depressant factors TNF-α and IL-1β through attenuating TLR4/NF-κB signal pathway activation and thus to improve myocardial function and decrease mortality.