Urinary catecholamine excretion, cardiovascular variability, and outcomes in tetanus.
Duc Hong DuNguyen Quan Nhu HaoNguyen Van HaoTran Tan ThanhHuynh Thi LoanLam Minh YenTran Thi Diem ThuyDuong Bich ThuyNguyen Thanh NguyenNguyen Thi Phuong DungEvelyne KestelynHa Thi Hai DuongNguyen Thanh PhongPham Thi TuyenNguyen Hoan PhuHo Dang Trung NghiaBui Thi Bich HanhPham Kieu Nguyet OanhPhan Vinh ThoPhung Tran Huy NhatPhan Nguyen Quoc KhanhDuncan WyncollNicholas P J DayNguyen Van Vinh ChauH Rogier van DoornLe Van TanRonald B GeskusC Louise ThwaitesPublished in: Tropical medicine and health (2023)
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.
Keyphrases
- heart rate
- blood pressure
- heart rate variability
- intensive care unit
- mechanical ventilation
- randomized controlled trial
- end stage renal disease
- ejection fraction
- newly diagnosed
- chronic kidney disease
- hypertensive patients
- acute respiratory distress syndrome
- prognostic factors
- systematic review
- skeletal muscle
- early onset
- escherichia coli
- oxidative stress
- adipose tissue
- patient reported outcomes
- healthcare
- blood glucose
- metabolic syndrome
- respiratory failure
- extracorporeal membrane oxygenation
- case report
- drug induced
- neural network
- case control