Impaired endothelium-dependent vasodilatation is a novel predictor of mortality in intensive care

Objective: Endothelial function may be impaired in critical illness. We hypothesized that impaired endothelium-dependent vasodilatation is a predictor of mortality in critically ill patients.
Design: Prospective observational cohort study.
Setting: Seventeen-bed adult intensive care unit in a tertiary referral university teaching hospital. Patients: Patients were recruited within 24 hrs of admission to the intensive care unit.
Interventions: The SphygmoCor Mx system was used to derive the aortic augmentation index from radial artery pulse pressure waveforms. Endothelium-dependent vasodilatation was calculated as the change in augmentation index in response to an endothelium-dependent vasodilator (salbutamol).
Measurements and Main Results: Demographics, severity of illness scores, and physiological parameters were collected. Statistically significant predictors of mortality identified using single regressor analysis were entered into a multiple logistic regression model. Receiver operator characteristic curves were generated. Ninety-four patients completed the study. There were 80 survivors and 14 nonsurvivors. The Simplified Acute Physiology Score II, the Sequential Organ Failure Assessment score, leukocyte count, and endothelium-dependent vasodilatation conferred an increased risk of mortality. In logistic regression analysis, endothelium-dependent vasodilatation was the only predictor of mortality with an adjusted odds ratio of 26.1 (95% confidence interval [CI], 4.3-159.5). An endothelium-dependent vasodilatation value of 0.5% or less predicted intensive care unit mortality with a sensitivity of 79% (CI, 59-88%) and specificity of 98% (CI, 94-99%).
Conclusions: In vivo bedside assessment of endothelium-dependent vasodilatation is an independent predictor of mortality in the critically ill. We have shown it to be superior to other validated severity of illness scores with high sensitivity and specificity.

'A new sword on an old anvil': W.B.Yeats, Robert Graves and the Anglo-Irish Tradition

Throughout his writing life, Robert Graves was consistently and often publicly hostile to the work of W.B. Yeats, whilst still also owing a considerable debt to the older poet (who he never met). This essay explores Graves' complex responses to Yeats, arguing that his antagonism may be understood in the light of his own Anglo-Irish background, and is implicated in his relations with his father, Alfred Perceval Graves, as well as his experience of the First World War. Probing the suggestiveness of Graves's claim in 1959 that his poems 'remain true to the Anglo-Irish poetic tradition into which I was born', it traces the relation between Yeats and Graves through correspondence, critical writings, and through a comparative reading of Yeats's A Vision and Graves's The White Goddess, and reveals underlying similarities in their critical and mythological thinking in spite of Graves's public disavowal of the Yeatsian aesthetic.