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Published on: December 10, 2020
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.
Background:
Upper gastrointestinal bleeding (UGIB) is a time-critical emergency where early identification of transfusion needs and hypovolemia is essential, yet conventional risk scores rely on often delayed laboratory and endoscopy data.
Objectives:
The primary objective of this study was to determine the prognostic value of the peripheral perfusion index (PPI) for predicting two critical outcomes in patients with UGIB: the requirement for blood transfusion and the development of hypovolemic shock.
Methods:
This prospective observational study enrolled 134 adult patients with endoscopically confirmed UGIB at a tertiary emergency department (ED). Following rest in a temperature-controlled room (24°C), PPI was measured. The primary outcomes were transfusion requirement and hypovolemic shock (systolic blood pressure [SBP] <90 mm Hg or shock index [SI] >1). PPI's predictive performance was evaluated against the shock index, lactate, and base deficit using receiver operating characteristic (ROC) analysis and multivariate logistic regression.
Results:
Of 134 patients (61.2% male, mean age 68.0 ± 14.7 years), 49.3% (n = 66) had a PPI <1.0. These patients demonstrated significantly higher rates of transfusion (71.2% vs. 27.9%, p < 0.001) and mortality (21.2% vs. 8.8%, p = 0.044). A PPI <1.0 was significantly associated with markers of severity, including lower blood pressure, higher shock index, and worse laboratory values (all p < 0.01). Multivariate analysis identified PPI <1.0 as a strong independent predictor of transfusion (OR: 7.68). PPI showed superior predictive accuracy for transfusion (area under the curve [AUC] = 0.771) compared to shock index (AUC = 0.750), lactate (AUC = 0.628), and base deficit (AUC = 0.682).
Conclusion:
A PPI value <1.0 was a strong independent predictor of transfusion need and demonstrated excellent discriminative power. The PPI is therefore a rapid, non-invasive bedside tool that reliably identifies patients with UGIB at risk of needing transfusions.
