biostudies-literatureStorms CRAmerican Heart AssociationNHLBI NIH HHSNIH HHS398https://www.ebi.ac.uk/biostudies/studies/S-EPMC12465633biostudies-literatureUnknown29(1)<h4>Background</h4>Ultrasound-measured brachial artery reactive hyperemia (RH) is independently predictive of hospital mortality in critically ill patients with sepsis. Its association with mortality is uncertain in critically ill patients in general.<h4>Methods</h4>This was a combined case-control and prospective cohort study. Ultrasound was used to measure brachial artery reactive hyperemia in 150 critically ill patients at a single academic medical center and in 44 control subjects without acute illness. Measurements were compared in cases versus controls, septic vs. non-septic critically ill patients, and hospital survivors vs. non-survivors. Follow-up measurements were obtained 3-5 days later in a sub-sample of patients.<h4>Results</h4>RH was calculated as the percent change in pre- vs. post-ischemic brachial artery velocity-time integral measured by Doppler ultrasound. RH was impaired in critically ill compared to control subjects (194 [179-210] vs. 369 [314-433]%, p < 0.001; results expressed as mean [95% confidence interval]) but similar in septic compared to non-septic patients (196 [177-217] vs. 199 [170-233], p = 0.88). RH was significantly lower in hospital non-survivors compared to survivors (144 [120-173] vs. 204 [187-222], p = 0.003). Multivariable analysis showed that the difference between survivors and non-survivors was not confounded by age or comorbidities (odds ratio for hospital death = 0.26 per log unit rise in RH, 95% confidence interval = 0.08-0.83, p = 0.02). The magnitude of RH improved over 3-5 days in hospital survivors (n = 63, 204 [180-232] vs. 239 [208-275], p = 0.02), but did not change in non-survivors (n = 11, 133 [107-165] vs. 128 [75-220].<h4>Conclusions</h4>Reactive hyperemia of the brachial artery is impaired in undifferentiated critically ill patients, lower in non-survivors compared to survivors, and independently associated with hospital mortality. Brachial artery reactive hyperemia improves significantly over time in survivors but not in non-survivors.Critical care (London, England)Ultrasound-measured brachial artery reactive hyperemia in critically ill patients: an observational study.PMC12465633R01 HL 1607233CRP17110114R01 HL160723Clark HDony CRovitelli AMKMalnoske MZhang JMaeda TBice TPietropaoli APKumar NStorms CRFe AZLevy EIllipparambil LCWexler OShultz RfalseUltrasound-measured brachial artery reactive hyperemia in critically ill patients: an observational study.<h4>Background</h4>Ultrasound-measured brachial artery reactive hyperemia (RH) is independently predictive of hospital mortality in critically ill patients with sepsis. Its association with mortality is uncertain in critically ill patients in general.<h4>Methods</h4>This was a combined case-control and prospective cohort study. Ultrasound was used to measure brachial artery reactive hyperemia in 150 critically ill patients at a single academic medical center and in 44 control subjects without acute illness. Measurements were compared in cases versus controls, septic vs. non-septic critically ill patients, and hospital survivors vs. non-survivors. Follow-up measurements were obtained 3-5 days later in a sub-sample of patients.<h4>Results</h4>RH was calculated as the percent change in pre- vs. post-ischemic brachial artery velocity-time integral measured by Doppler ultrasound. RH was impaired in critically ill compared to control subjects (194 [179-210] vs. 369 [314-433]%, p < 0.001; results expressed as mean [95% confidence interval]) but similar in septic compared to non-septic patients (196 [177-217] vs. 199 [170-233], p = 0.88). RH was significantly lower in hospital non-survivors compared to survivors (144 [120-173] vs. 204 [187-222], p = 0.003). Multivariable analysis showed that the difference between survivors and non-survivors was not confounded by age or comorbidities (odds ratio for hospital death = 0.26 per log unit rise in RH, 95% confidence interval = 0.08-0.83, p = 0.02). The magnitude of RH improved over 3-5 days in hospital survivors (n = 63, 204 [180-232] vs. 239 [208-275], p = 0.02), but did not change in non-survivors (n = 11, 133 [107-165] vs. 128 [75-220].<h4>Conclusions</h4>Reactive hyperemia of the brachial artery is impaired in undifferentiated critically ill patients, lower in non-survivors compared to survivors, and independently associated with hospital mortality. Brachial artery reactive hyperemia improves significantly over time in survivors but not in non-survivors.2025-01-01T00:00:00Z2025 Sep2026-06-03T21:13:10.447Z2026-05-01T03:10:39.596ZS-EPMC124656334099943410.1186/s13054-025-05646-7