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Peripheral ischemic reserve in sepsis and septic shock as a new bedside prognostic enrichment tool: A Brazilian

Ana Carolina de Miranda1, Fernanda do Carmo De Stefani1, Bruna Cassia Dal Vesco2

  • 1Department of Internal Medicine, Hospital de Clínicas, Federal University of Paraná, Curitiba, Paraná, Brazil.

Plos One
|July 5, 2023
PubMed

Insights

High peripheral ischemic microvascular reserve (PIMR) indicates increased mortality risk in sepsis patients. This finding is particularly significant for those with septic shock, suggesting PIMR

Area of Science:

  • Critical Care Medicine
  • Cardiovascular Physiology
  • Sepsis Pathophysiology

Background:

  • Sepsis-associated microvascular dysfunction is linked to poor patient outcomes.
  • Peripheral ischemic microvascular reserve (PIMR) and its clinical utility in sepsis remain unestablished.
  • Assessing PIMR may offer prognostic insights into sepsis-induced microvascular dysfunction.

Purpose of the Study:

  • To investigate the association between high PIMR and mortality in sepsis patients.
  • To evaluate PIMR's prognostic value in sepsis subgroups, including septic shock.
  • To explore the relationship between PIMR and peripheral perfusion parameters like capillary refill time.

Main Methods:

  • An observational cohort study involving 226 consecutive septic patients across four ICUs.
  • PIMR was assessed using oximetry-derived peripheral perfusion index (PPI) and post-occlusive reactive hyperemia over two days.
  • Statistical analyses included risk ratios, multivariate adjustment, and correlation coefficients.

Main Results:

  • Higher mortality was observed in patients with high PIMR on day one (RR 1.25, p=0.04), a finding sustained after adjustment.
  • The association between high PIMR and mortality was significant in the septic shock subgroup (RR 2.14, p=0.01).
  • A moderate positive correlation (r=0.41) was found between PIMR (ΔPPI peak) and capillary refill time within 24 hours.

Conclusions:

  • High PIMR detected within 24 hours of sepsis diagnosis is a prognostic marker for mortality.
  • PIMR shows potential as a prognostic enrichment tool, especially in patients with septic shock.
  • Further research may elucidate PIMR's role in guiding sepsis management and improving outcomes.

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