Antioxidant Role in Critically Ill Patients with Vasodilatory Shock: Does Glutathione Peroxidase Correlate to Severity of Tissue Hypoxia and Organ Failure

Abstract

Purpose

We aimed to evaluate the antioxidant role in critically ill patients with vasodilatory shock as it relates to severity of tissue hypoxia and organ failure.

Patients and Methods

An observational and prospective study was conducted in critically ill patients with vasodilatory shock. Glutathione peroxidase (GPx) levels as antioxidants were measured based on their levels in the patient’s serum. Tissue hypoxia as micro-hemodynamic status was represented by lactate levels, the macro-hemodynamic status was represented by vasoactive inotropic score (VIS) and mean arterial pressure (MAP), while organ dysfunction severity was represented by the shock index (SI), the sequential organ failure assessment (SOFA) score, and the acute physiology and chronic health evaluation (APACHE) II score.

Results

Thirty-four critically ill patients with vasodilatory shock met the eligibility criteria. The mortality rate was 41.2%. Glutathione peroxidase levels did not show a significant difference between survivors and non-survivors at baseline or after 24 hours. At the initial measurement, there was a correlation between GPx and lactate levels, GPx and SOFA scores. The macrohemodynamic status was represented by VIS and MAP, which were correlated with SI.

Conclusion

Glutathione peroxidase as antioxidant is related to severity of tissue hypoxia and organ failure in critically ill patients with vasodilatory shock.

Keywords:

• glutathione peroxidase
• severity
• mortality
• vasodilatory shock
• critically ill

Abbreviations

APACHE, Acute Physiology and Chronic Health Evaluation; AUC, area under curve; GPx, glutathione peroxidase; GR, glutathione reductase; GSH, reduced glutathione; GSSG, oxidized glutathione; ICU, Intensive Care Unit; MAP, mean arterial pressure; NADPH, reduced nicotinamide adenine dinucleotide phosphate; NADP⁺, nicotinamide adenine dinucleotide phosphate; ROS, reactive oxygen species; SI, Shock Index; SOFA, Sequential Organ Failure Assessment; SVR, systemic vascular resistance; VIS, vvasoactive inotropic score.

Ethical Consideration

This study was conducted in compliance with the Declaration of Helsinki. We obtained ethical approval from the Ethical Committee of the Faculty of Medicine, Universitas Airlangga - Dr. Soetomo General Academic Hospital (ethical clearance number 0348/KEPK/XII/2021).

Acknowledgments

We thank all teachers, the resident, nursing staff, laboratory staff in Soetomo General Academic Hospital, Faculty of Medicine, Universitas Airlangga; and the staff of Institute of Tropical Disease, Universitas Airlangga who are involved in patient management and data collection. We also thank Reza Affandi for helping us with the editing assistance.

Author Contributions

All authors made a significant contribution to the work reported, whether that is in the conception, study design, execution, acquisition of data, analysis and interpretation, or in all these areas; took part in drafting, revising or critically reviewing the article; gave final approval of the version to be published; have agreed on the journal to which the article has been submitted; and agree to be accountable for all aspects of the work.

Disclosure

The authors report no conflicts of interest in this work.

Additional information

Funding

The authors report no funding source.