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The Accuracy of the Passive Leg Raising Test Using the Perfusion Index to Identify Preload Responsiveness-A Single
Marialessia Casazzo1, Luigi Pisani1,2,3, Rabiul Alam Md Erfan Uddin4
1Department of Anesthesia and Intensive Care, University of Bari, 70124 Bari, Italy.
Diagnostics (Basel, Switzerland)
|January 11, 2025
Summary
The passive leg raising test (PLR) using perfusion index (PI) accurately predicts fluid responsiveness in critically ill patients with hypoperfusion. Diagnostic accuracy was highest when PI changes were measured at baseline.
Area of Science:
- Critical Care Medicine
- Cardiovascular Physiology
- Point-of-Care Diagnostics
Background:
- Hypoperfusion is a critical condition in critically ill patients, often requiring fluid administration.
- Accurate assessment of fluid responsiveness is vital for optimizing hemodynamic management.
- Resource-limited settings present unique challenges for advanced hemodynamic monitoring.
Purpose of the Study:
- To evaluate the accuracy of the passive leg raising test (PLR) using perfusion index (PI) for predicting preload responsiveness.
- To assess the diagnostic performance of PLR with PI in critically ill patients with hypoperfusion in a resource-limited setting.
- To compare the accuracy of PLR with PI at different time points (baseline and up to 72 hours).
Main Methods:
- Prospective observational single-center study in Chattogram, Bangladesh.
- Inclusion of critically ill patients with sepsis or severe malaria and signs of hypoperfusion.
- Performance of PLR test at baseline and at 6, 24, 48, and 72 hours, measuring PI.
- Comparison of PI-assessed preload responsiveness with cardiac index (CI) change (≥5%) as the reference standard.
- Construction of Receiver Operating Characteristic (ROC) curves to determine accuracy.
Main Results:
- The study included 34 sepsis and 10 severe malaria patients.
- A PI change cutoff of 9.7% best discriminated responders from non-responders.
- PLR using PI demonstrated good accuracy at baseline (Area Under ROC curve [AUROC] 0.87).
- The test exhibited high sensitivity and negative predictive value, with lower specificity and positive predictive value.
- Diagnostic accuracy (AUROC) decreased at later time points (6-72 hours) compared to baseline.
Conclusions:
- Changes in PI following a PLR test effectively detect preload responsiveness in patients with sepsis or severe malaria and hypoperfusion.
- The diagnostic accuracy of PLR using PI is superior when measurements are taken at baseline.
- This method offers a valuable tool for fluid management in resource-limited critical care settings.
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