Performance of nitric oxide in sepsis: a scoping review

Vieira, Neireana Florêncio; Barbosa, Tais Pagliuco; Cárnio, Evelin Capellari

doi:10.37689/acta-ape/2024AR00005122

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Brasil

Acta Paulista de Enfermagem

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Brasil

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Sumário

Review Article • Acta Paul Enferm 37 • 2024 • https://doi.org/10.37689/acta-ape/2024AR00005122 copy

Performance of nitric oxide in sepsis: a scoping review

Authorship SCIMAGO INSTITUTIONS RANKINGS

Abstract

Objective

Map the available evidence on the actions of nitric oxide in the pathophysiology of sepsis and its relationship with the severity of sepsis in patients.

Method

Scoping review following the Joanna Briggs Institute methodology. A search was carried out for studies that highlighted the actions of nitric oxide in sepsis, informing whether its increase is associated with the severity of sepsis in patients. Two independent reviewers mapped the information using a previously designed data extraction instrument. The data was analyzed for its relevance and then extracted and synthesized.

Results

Eleven of 1342 studies were included in the review. The first of them was published in 2017 and the last in 2022. Most of them were developed in the USA, China, and Germany. Studies have reported the actions and bioavailability of nitric oxide and endogenous inhibitors related to its production, and related nitric oxide to the severity of sepsis.

Conclusion

The physiological production of nitric oxide during sepsis acts as a vascular protector, mainly in the microcirculation but contributes to vascular dysfunction in high concentrations, subverting the regulation of blood pressure, causing deep vasodilation and refractory hypotension, and increasing the severity of sepsis in patients. Registration of the scoping review in the Open Science Framework: https://doi.org/10.17605/OSF.IO/MXDK2

Sepsis; Septic shock; Nitric oxide; Multiple organ failure; Patient acuity

Bases	Strategies
Medline / PubMed	(“sepsis” AND “nitric oxide”), (“sepsis” AND “nitric oxide” AND “dysfunction”), (“sepsis” AND “nitric oxide” AND “multiple organ failure”) (“sepsis” AND “nitric oxide” OR “nitric oxide sintase”), (“nitric oxide” AND “patient acuity” AND “sepsis”), (“nitric oxide” AND “patient acuity” AND “Shock septic”).
LILACS	(“sepsis” AND “nitric oxide”), (“sepsis” AND “nitric oxide” AND “multiple organ failure”) (“sepsis” AND “nitric oxide” OR “nitric oxide sintase”), (“nitric oxide” AND “patient acuity” AND “Shock septic”).
EMBASE	(“sepsis” AND “nitric oxide”), (“sepsis” AND “nitric oxide” AND “multiple organ failure”), (“nitric oxide” AND “patient acuity” AND “sepsis”).
SCIELO	(“sepsis” AND “nitric oxide”), (“sepsis” AND “nitric oxide” AND “multiple organ failure”), (“nitric oxide” AND “patient acuity” AND “sepsis”), (“nitric oxide” AND “patient acuity” AND “Shock septic”).

Authors Years of Publication No. of Citations	Study Countries	Objectives	Study designs
Yu MH, Chen MH, Han F, Li Q, Sun RH, Tu YX. 2018⁽⁵⁾	China	To evaluate serum levels of amyloid A (SAA) and NO in comparison with predictive markers of C-reactive protein (CRP) and APACHE II score in groups of patients with septic and non-septic shock.	Randomized Study
Kumar S, Gupta E, SrivastavaVK, Kaushik S, Saxena J, Goyal LK, et al. 2019⁽⁶⁾	India	To evaluate the link between nitrosative stress and pro-inflammatory cytokines and correlate with the severity of sepsis and associated organ dysfunction.	Randomized Study
Bath PM, Coleman CM, Gordon AL, Lim WS, Webb AJ. 2021⁽¹⁰⁾	England	To evidence the activity of NO in viral, bacterial, protozoal, and fungal infections in vitro, in vivo, and early-phase clinical studies.	Integrative Review
Winkler MS, Kluge S, Holzmann M, Moritz E, Robbe L, Bauer A. et al. 2017⁽¹¹⁾	Germany	To investigate whether concentrations of marker surrogates for NO bioavailability are associated with sepsis severity.	Randomized Study
Porrini C, Ramarao N, Tran SL. 2020⁽¹²⁾	France	To know the beneficial or harmful functions of NO in humans, pathogenic bacteria, and microbiota, and the mechanisms used by them to produce, use, or resist NO.	Integrative Review
Webber RJ, Sweet RM, Webber DS. 2019⁽¹³⁾	USA	To analyze plasma inducible nitric oxide synthase (iNOS) as an early and specific biomarker for the onset of sepsis.	Clinical Trial
Hu S, Pi Q, Xu X, Yan J, Guo Y, Tan W. et al. 2021⁽¹⁴⁾	China	To explore the performance effect of eNOS in sepsis-induced endothelial dysfunction in septic mice and cellular models.	Randomized Study
Singh J, Lee Y, Kellum JA. 2022⁽¹⁵⁾	USA	To evidence whether reducing asymmetric dimethylarginine (ADMA) in patients with sepsis could be a potential therapeutic approach to attenuate progressive organ damage and mortality from sepsis.	Integrative Review
Dao VTV, Elbatreek MH, Fuch T, Gradler U, Schmidt HHHW, Shah, AM. et al. 2021⁽¹⁶⁾	Germany	To map the effects of NO inhibition in clinical practice in septic patients.	Integrative Review
Takatani Y, Ono K, Suzuki H, Inaba M, Sawada M, Matsuda N. 2018⁽¹⁷⁾	Japan	To analyze the NO plasma levels and their relationship with body temperature in two species of mice with sepsis.	Experimental Study
Oliveira FRMB, Assreuy J, Sordi R. 2022⁽¹⁸⁾	Brazil	To understand the pathophysiological mechanisms of NO in acute kidney injury associated with sepsis.	Integrative Review

Escola Paulista de Enfermagem, Universidade Federal de São Paulo R. Napoleão de Barros, 754, 04024-002 São Paulo - SP/Brasil, Tel./Fax: (55 11) 5576 4430 - São Paulo - SP - Brazil
E-mail: actapaulista@unifesp.br

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[1] Corresponding author: Neireana Florêncio Vieira Email: nfvieira30@gmail.com