Urinary catecholamine excretion, cardiovascular variability, and outcomes in tetanus.

Autor: Du DH; Oxford University Clinical Research Unit, Ho Chi Minh City, Vietnam. ducdh@oucru.org., Hao NQN; Oxford University Clinical Research Unit, Ho Chi Minh City, Vietnam.; University Medical Center, Ho Chi Minh City, Vietnam., Van Hao N; University Medical Center, Ho Chi Minh City, Vietnam.; Hospital for Tropical Diseases, Ho Chi Minh City, Vietnam., Thanh TT; Oxford University Clinical Research Unit, Ho Chi Minh City, Vietnam., Loan HT; Hospital for Tropical Diseases, Ho Chi Minh City, Vietnam., Yen LM; Oxford University Clinical Research Unit, Ho Chi Minh City, Vietnam., Thuy TTD; Hospital for Tropical Diseases, Ho Chi Minh City, Vietnam., Thuy DB; Hospital for Tropical Diseases, Ho Chi Minh City, Vietnam., Nguyen NT; Hospital for Tropical Diseases, Ho Chi Minh City, Vietnam., Dung NTP; Oxford University Clinical Research Unit, Ho Chi Minh City, Vietnam., Kestelyn E; Oxford University Clinical Research Unit, Ho Chi Minh City, Vietnam.; Centre for Tropical Medicine and Global Health, University of Oxford, Oxford, UK., Duong HTH; Hospital for Tropical Diseases, Ho Chi Minh City, Vietnam., Phong NT; Hospital for Tropical Diseases, Ho Chi Minh City, Vietnam., Tuyen PT; Hospital for Tropical Diseases, Ho Chi Minh City, Vietnam., Phu NH; Hospital for Tropical Diseases, Ho Chi Minh City, Vietnam., Nghia HDT; Hospital for Tropical Diseases, Ho Chi Minh City, Vietnam.; Pham Ngoc, Thach Medicine University, Ho Chi Minh City, Vietnam., Hanh BTB; Hospital for Tropical Diseases, Ho Chi Minh City, Vietnam.; Pham Ngoc, Thach Medicine University, Ho Chi Minh City, Vietnam., Oanh PKN; Hospital for Tropical Diseases, Ho Chi Minh City, Vietnam., Tho PV; Hospital for Tropical Diseases, Ho Chi Minh City, Vietnam., Nhat PTH; Oxford University Clinical Research Unit, Ho Chi Minh City, Vietnam., Khanh PNQ; Oxford University Clinical Research Unit, Ho Chi Minh City, Vietnam., Wyncoll D; Guys and St, Thomas' Hospitals, London, UK., Day NPJ; Centre for Tropical Medicine and Global Health, University of Oxford, Oxford, UK.; Mahidol Oxford Research Unit, Bangkok, Thailand., Van Vinh Chau N; Hospital for Tropical Diseases, Ho Chi Minh City, Vietnam., van Doorn HR; Oxford University Clinical Research Unit, Ho Chi Minh City, Vietnam.; Centre for Tropical Medicine and Global Health, University of Oxford, Oxford, UK., Van Tan L; Oxford University Clinical Research Unit, Ho Chi Minh City, Vietnam., Geskus RB; Oxford University Clinical Research Unit, Ho Chi Minh City, Vietnam.; Centre for Tropical Medicine and Global Health, University of Oxford, Oxford, UK., Thwaites CL; Oxford University Clinical Research Unit, Ho Chi Minh City, Vietnam.; Centre for Tropical Medicine and Global Health, University of Oxford, Oxford, UK.
Jazyk: angličtina
Zdroj: Tropical medicine and health [Trop Med Health] 2023 Mar 30; Vol. 51 (1), pp. 20. Date of Electronic Publication: 2023 Mar 30.
DOI: 10.1186/s41182-023-00512-0
Abstrakt: Severe tetanus is characterized by muscle spasm and cardiovascular system disturbance. The pathophysiology of muscle spasm is relatively well understood and involves inhibition of central inhibitory synapses by tetanus toxin. That of cardiovascular disturbance is less clear, but is believed to relate to disinhibition of the autonomic nervous system. The clinical syndrome of autonomic nervous system dysfunction (ANSD) seen in severe tetanus is characterized principally by changes in heart rate and blood pressure which have been linked to increased circulating catecholamines. Previous studies have described varying relationships between catecholamines and signs of ANSD in tetanus, but are limited by confounders and assays used. In this study, we aimed to perform detailed characterization of the relationship between catecholamines (adrenaline and noradrenaline), cardiovascular parameters (heart rate and blood pressure) and clinical outcomes (ANSD, mechanical ventilation required, and length of intensive care unit stay) in adults with tetanus, as well as examine whether intrathecal antitoxin administration affected subsequent catecholamine excretion. Noradrenaline and adrenaline were measured by ELISA from 24-h urine collections taken on day 5 of hospitalization in 272 patients enrolled in a 2 × 2 factorial-blinded randomized controlled trial in a Vietnamese hospital. Catecholamine results measured from 263 patients were available for analysis. After adjustment for potential confounders (i.e., age, sex, intervention treatment, and medications), there were indications of non-linear relationships between urinary catecholamines and heart rate. Adrenaline and noradrenaline were associated with subsequent development of ANSD, and length of ICU stay.
(© 2023. The Author(s).)
Databáze: MEDLINE
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