Observational studyCritical care explorations2025
Biomarkers of Microcirculatory Dysfunction in Sepsis: A Pilot Prospective Observational Study.
Observational study in Critical care explorations, 2025. The graph could read no effect estimate from its abstract, so it casts no vote on the map. Cited by 2 papers, 1 of them a synthesis that pooled it.
What it found
Each row is one number read from the abstract, on the scale the paper reported it, with its interval. Left of the dashed line favours the treatment, right favours the comparator. Under each row is the sentence it came from. New to these charts? A ten-minute tutorial.
The abstract states no effect estimate the extractor could read, or names no intervention and outcome on the map, so this paper lights no cell and moves no belief. It is still indexed, cited and linked below.
The trial behind it
Trials whose registry record cites this paper, or whose number appears in the abstract. A trial that started after this paper was published is citing it as background, not reporting it.
Neither the registry nor the abstract names a trial number. If this is a trial report, that itself is worth knowing.
Who cites it
2 citing papers in PubMed, 1 synthesis or guideline pooled it.
- Meta-Analysis of the Prognostic Value of Skin Perfusion Parameters in Sepsis Patients: Evidence Integration Based on the Mottling Score, Capillary Refill Time, and Peripheral Perfusion Index.Shock (Augusta, Ga.) · 2026Pooled it
- The Physiology, Pathophysiology, and Clinical Implications of Fluid Resuscitation in Critically Ill Patients.Cureus · 2026Review
Corrections and comments
PubMed lists nothing against this paper. Absence here is not a guarantee, only a check that was made.
Authors and funding
13 authors.
Funding
Abstract
contextTo evaluate and compare sublingual microscopy (SLM) to urinary glycosaminoglycan (GAG) assays, dimethylmethylene blue (DMMB) assay, and liquid chromatography tandem mass spectrometry (LC-MS/MS) quantification of GAGs as biomarkers of microvascular dysfunction in patients with sepsis and septic shock. HYPOTHESIS: Indicators of microvascular dysfunction and markers of endothelial glycocalyx (eGC) degradation would be associated with sepsis. METHODS AND MODELS: Prospective, observational case-control study.
settingDenver Health Medical Center, a safety-net hospital in Denver, CO. SUBJECTS: Forty-four adult patients with sepsis or septic shock and 24 healthy control patients undergoing elective orthopedic procedures. Exclusion criteria included pregnancy and incarceration.
resultsSublingual microvascular parameters (De Backer Density, proportion of perfused vessels) were measured using darkfield sidestream microscopy, and urinary GAGs were measured via DMMB colorimetric assay and LC-MS/MS targeting heparan sulfate (HS), dermatan sulfate, and keratan sulfate. Validation of HS quantification was performed on a subset using hydrophilic interaction liquid chromatography-mass spectrometry (HILIC-MS). LC-MS/MS HS was significantly higher in sepsis vs. controls (Area under the curve 0.85; 95% CI, 0.76-0.95), demonstrating higher diagnostic performance than SLM (De Backer Density AUC 0.71) and DMMB GAGs (AUC 0.62). LC-MS/MS and HILIC-MS HS levels were strongly correlated (R² = 0.97, p < 0.001). DMMB GAGs were associated with HS subtypes (p = 0.05) and SLM density (p = 0.03). No significant associations with in-hospital mortality or acute kidney injury were observed. INTERPRETATION AND
conclusionsAmong the evaluated modalities, LC-MS/MS quantification of HS showed the greatest discriminative ability for identifying sepsis and correlated strongly with established mass spectrometric methods. SLM exhibited moderate diagnostic utility and significant associations with GAG levels, reinforcing its biologic relevance. However, its bedside application may be limited by challenges in image acquisition and analysis. The concordance across SLM, DMMB, and LC-MS/MS supports eGC degradation as a key feature of sepsis pathophysiology. These findings highlight the promise of LC-MS/MS as a scalable, rapid, and mechanistically informed platform for biomarker-driven enrichment in future sepsis trials and clinical care.
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