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Perfusion Index Variations in Children With Septic Shock: Single-Center Observational Cohort Study in India
Lalitha Av1, Siji Kuzhikkombil Mani1, Santu Ghosh2
1Department of Pediatric Critical Care, St Johns Medical College and Hospital, Bengaluru, Karnataka, India.
Insights
Peripheral perfusion index (PI) in children with septic shock negatively correlates with lactate levels. A critical PI threshold at 6 hours shows potential for mortality prediction but requires further validation.
Area of Science:
- Pediatric Critical Care Medicine
- Hemodynamics
- Biomarkers
Background:
- Septic shock in children is a life-threatening condition requiring timely intervention.
- Peripheral perfusion index (PI), derived from pulse oximetry, offers a non-invasive hemodynamic assessment.
- Understanding PI dynamics and its correlation with established markers like lactate is crucial for patient management.
Purpose of the Study:
- To investigate the variation in peripheral perfusion index (PI) in children with septic shock.
- To determine the correlation between PI and serum lactate concentration.
- To explore the diagnostic utility of PI in predicting mortality in pediatric septic shock.
Main Methods:
- A prospective observational study was conducted in a tertiary hospital's pediatric emergency department and PICU.
- 112 children aged 1 month to 16 years with septic shock were enrolled.
- Peripheral perfusion index (PI) and serum lactate levels were recorded at admission and 6 hours, alongside demographic and outcome data.
Main Results:
- Overall mortality was 22% (25/112 children).
- A negative correlation was observed between PI and lactate at admission (r = -0.27, p=0.006) and at 6 hours (r = -0.21, p=0.03).
- A PI cutoff of ≤0.6 at 6 hours showed an AUC of 0.74 for mortality prediction, with 70% sensitivity and 81% specificity.
Conclusions:
- Peripheral perfusion index (PI) is negatively correlated with serum lactate levels in children with septic shock.
- While a PI threshold of ≤0.6 at 6 hours demonstrates potential in predicting mortality, its clinical utility requires further investigation due to considerable uncertainty.
Objectives:
To study in children with septic shock: 1) variation in peripheral perfusion index (PI), which is a derived variable from pulse oximetry; 2) correlation between PI and lactate concentration; and 3) exploratory diagnostic evaluation between mortality and PI.
Design:
Prospective observational study (from October 2018 to March 2020).
Setting:
Pediatric emergency department and PICU of a tertiary hospital in India.
Patients:
Children (1 mo to 16 yr old) with septic shock.
Interventions:
None.
Measurements And Main Results:
Data collected included demographic, clinical, laboratory, and outcome-related variables. Hemodynamic variables like heart rate, mean arterial pressure, and PI, along with serum lactate were recorded at specified intervals. A total of 112 children with septic shock were recruited, with median (interquartile range [IQR]) age of 50 (IQR 12,118.5) months and 65 of 112 (58%) were male children. Overall mortality was 25 of 112 (22%). At admission, the median PI was 0.6 (IQR -0.30, 0.93), and we used PI less than or equal to 0.6 to define a "critical PI." Of 61 children with critical PI at admission, 26 of 61 increased above this threshold by 6 hours. We observed a negative correlation between PI and lactate, at admission ( r = -0.27; 95% CI, -0.44 to -0.08; p = 0.006) and at 6 hours ( r = -0.21; 95% CI, -0.39 to -0.02; p = 0.03). In the exploratory analysis, a PI cutoff of less than or equal to 0.6 at 6 hours had area under the receiver operating curve of 0.74 (95% CI, 0.60-0.88). That is, with a 70% sensitivity and 81% specificity for mortality, the performance of such a test in our population (pre-to-post-test probability) for mortality would be 0.22-0.51.
Conclusions:
We have used pulse oximetry-derived PI in children presenting with septic shock and found that the value is negatively correlated with a rise in serum lactate concentration. However, the utility of using a critical threshold value in PI (≤ 0.6) after 6 hours of treatment to be indicative of later mortality has considerable uncertainty.
