The Prognostic Value of Capillary Refill Time in Patients With Sepsis: A Prospective Cohort Study

Sepsis is life-threatening due to organ dysfunction from a dysregulated host response. Despite macrohemodynamic stabilisation, microcirculatory disturbances may persist. Capillary refill time (CRT) is a simple bedside indicator of microcirculatory perfusion, but its dynamic prognostic value over time is underexplored.

To observe CRT changes in sepsis patients and evaluate its predictive value at different time points.

This prospective cohort study enrolled sepsis patients receiving bundle therapy at a single centre. Patients were grouped by 28-day survival. Baseline data, CRT, lactate (Lac) and central venous pressure (CVP) were measured at eight time points (pre-treatment to 72 h) compare inter-group and intra-group differences. Spearman's correlation assessed CRT-Lac/CVP relationships. ROC analysis evaluated CRT's prognostic value.

Of 86 patients (70 survived, 16 non-survivors), significant inter-group differences (p < 0.05) were found in age, SOFA score, lactate and vasoactive drug dosage. CRT and Lac differed significantly between groups at all time points (p < 0.05), while CVP differed at 3, 24 and 72 h. Intra-group comparisons showed significant changes in all parameters over time (p < 0.01). CRT correlated negatively with CVP in survivors (r = -0.358, p < 0.001). In non-survivors, CRT positively correlated with Lac and negatively with CVP (r = 0.416 and -0.553, both p < 0.001). ROC analysis indicated 3-h post-treatment CRT had the highest predictive value (AUC = 0.981, sensitivity 93.8%, specificity 97.1%). Spearman correlation analysis revealed a positive correlation between ΔCRT₃h and ΔLac₃h in both patient groups: ρ = 0.25, p = 0.035 in the survival group and ρ = 0.52, p < 0.001 in the non-survival group.

CRT is a valuable prognostic marker in sepsis, with 3-h CRT showing the strongest predictive performance. Its monitoring may guide early treatment decisions.

This study validates nurse-measured capillary refill time (CRT) as a simple, early-warning tool. A prolonged 3-h CRT accurately identifies high-risk septic patients, enabling nurses to prioritise care and guide timely resuscitation at the bedside.