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Related Concept Videos

Esophageal Varices-II: Clinical Features and Management01:28

Esophageal Varices-II: Clinical Features and Management

Esophageal varices often manifest as gastrointestinal bleeding episodes, presenting symptoms like hematemesis (vomiting of blood), hematochezia (passing fresh blood via the rectum), and melena (black, tarry stools). Other signs can include weight loss, anorexia, abdominal discomfort, jaundice, pruritus, altered mental status, and muscle cramps.
In the initial assessment, a thorough review of the patient's medical history is vital to identify risk factors such as liver disease, alcohol abuse, or...

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Real-Time Assessment of Spinal Cord Microperfusion in a Porcine Model of Ischemia/Reperfusion
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Peripheral Perfusion Index Predicts Transfusion Need in Upper Gastrointestinal Bleeding: A Prospective Observational

Zeynep Akı1, Engin Ozakin1, Nurdan Acar1

  • 1Faculty of Medicine, Emergency Department, Eskisehir Osmangazi University, Eskisehir, Turkey.

The Journal of Emergency Medicine
|May 21, 2026
PubMed
Summary

A low peripheral perfusion index (PPI) <1.0 in upper gastrointestinal bleeding (UGIB) patients strongly predicts the need for blood transfusions. This rapid, non-invasive bedside tool aids early risk identification in critical emergencies.

Keywords:
UGIBemergency departmenthypovolemiaperipheral perfusion indexshock indextransfusion

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Area of Science:

  • Emergency Medicine
  • Critical Care
  • Gastroenterology

Background:

  • Upper gastrointestinal bleeding (UGIB) is a critical emergency requiring prompt assessment of transfusion needs and hypovolemia.
  • Conventional risk scores often depend on delayed laboratory and endoscopy results, hindering timely intervention.

Purpose of the Study:

  • To evaluate the prognostic value of the peripheral perfusion index (PPI) in predicting blood transfusion requirements and hypovolemic shock in UGIB patients.
  • To compare the predictive accuracy of PPI against established markers like shock index and lactate levels.

Main Methods:

  • A prospective observational study involving 134 adult UGIB patients in a tertiary emergency department.
  • Peripheral perfusion index (PPI) was measured after a rest period.
  • Outcomes included transfusion requirement and hypovolemic shock; predictive performance was assessed using ROC analysis and logistic regression.

Main Results:

  • A PPI <1.0 was observed in 49.3% of patients and was significantly associated with higher transfusion rates (71.2% vs. 27.9%) and mortality (21.2% vs. 8.8%).
  • PPI <1.0 independently predicted transfusion need (OR: 7.68) and demonstrated superior accuracy (AUC=0.771) compared to shock index (AUC=0.750), lactate (AUC=0.628), and base deficit (AUC=0.682).

Conclusions:

  • A peripheral perfusion index (PPI) <1.0 is a robust, independent predictor of transfusion requirements in UGIB patients.
  • PPI offers a rapid, non-invasive bedside method for identifying high-risk patients, facilitating timely clinical decisions.