Early peripheral perfusion index predicts 28-day outcome in patients with septic shock

doi:10.5847/wjem.j.1920-8642.2024.081

Abstract

Abstract:

BACKGROUND To investigate the prognostic value of the peripheral perfusion index (PPI) in patients with septic shock.

METHODS This prospective cohort study, conducted at the emergency intensive care unit of Peking University People's Hospital, recruited 200 patients with septic shock between January 2023 and August 2023. These patients were divided into survival (n=84) and death (n=116) groups based on 28-day outcomes. Clinical evaluations included laboratory tests and clinical scores, with lactate and PPI values assessed upon admission to the emergency room and at 6 h and 12 h after admission. Risk factors associated with mortality were analyzed using univariate and multivariate Cox regression analyses. Receiver operator characteristic (ROC) curve was used to assess predictive performance. Mortality rates were compared, and Kaplan-Meier survival plots were created.

RESULTS Compared to the survival group, patients in the death group were older and had more severe liver damage and coagulation dysfunction, necessitating higher norepinephrine doses and increased fluid replacement. Higher lactate levels and lower PPI levels at 0 h, 6 h, and 12 h were observed in the death group. Multivariate Cox regression identified prolonged prothrombin time (PT), decreased 6-h PPI and 12-h PPI as independent risk factors for death. The area under the curves for 6-h PPI and 12-h PPI were 0.802 (95% CI 0.742-0.863, P<0.001) and 0.945 (95% CI0.915-0.974, P<0.001), respectively, which were superior to Glasgow Coma Scale (GCS), Sequential Organ Failure Assessment (SOFA) scores (0.864 and 0.928). Cumulative mortality in the low PPI groups at 6 h and 12 h was significantly higher than in the high PPI groups (6-h PPI: 77.52% vs. 22.54%; 12-h PPI: 92.04% vs. 13.79%, P<0.001).

CONCLUSION PPI may have value in predicting 28-day mortality in patients with septic shock.

Key words: Peripheral perfusion index, Septic shock, Prognosis, Predictive value

Cheng Chi, Hao Gong, Kai Yang, Peng Peng, Xiaoxia Zhang. Early peripheral perfusion index predicts 28-day outcome in patients with septic shock[J]. World Journal of Emergency Medicine, 2024, 15(5): 372-378.

Figures/Tables 5

Table 1.

The demographic and baseline clinical characteristics of patients with septic shock

Variables	Survival group (n=84)	Death group (n=116)	χ²/Z/t	P-value
Age, years	56.79±18.32	65.60±15.08	-3.727	<0.001
Male	48 (57.14)	76 (65.51)	1.450	0.228
Underlying disease
Diabetes	25 (29.76)	32 (27.59)	0.113	0.737
Hypertension	48 (57.14)	62 (53.45)	0.408	0.523
CHD	21 (25.00)	32 (27.59)	0.167	0.683
Tumor	4 (4.76)	3 (2.59)	0.191	0.662
CKD	18 (21.43)	12 (10.34)	4.694	0.030
Immunological diseases	0 (0)	12 (10.34)	9.244	0.002
Onset time, h	8 (2, 22)	7 (5, 20)	-0.088	0.930
Vital signs
T, °C	37.54±1.80	37.50±1.42	0.181	0.856
HR, beats/min	135 (108, 153)	120 (66, 148)	-1.640	0.101
MAP, mmHg	61 (53, 65)	63 (55, 66)	-0.829	0.407
Respiratory rate, breaths/min	25 (20, 33)	22 (18, 33)	-0.881	0.378
Etiology			0.987	0.964
Lung infection	59 (70.23 )	81 (69.82)
Abdominal infection	18 (21.43)	26 (22.41)
Intracranial infection	4 (4.76)	4 (3.45)
Catheter-related infection	2 (2.38)	2 (1.72)
Skin and soft tissue infection	1 (1.19)	3 (2.59)
Clinical score
GCS score	15 (5, 15)	3 (3, 3)	-9.749	<0.001
SOFA score	6 (4, 8)	12 (10, 14)	-10.351	<0.001
APACHE II score	19 (16, 24)	37 (32, 40)	-11.525	<0.001
Blood testing
Oxygenation index	179 (91, 264)	189 (96, 280)	-0.728	0.467
WBC, ×10⁹/L	11.20 (7.94, 16.36)	11.20 (7.94, 16.59)	-0.124	0.901
Hb, g/L	112.89±40.43	108.97±39.43	0.684	0.495
PLT, ×10⁹/L	165 (125, 244)	166 (127, 236)	-0.288	0.773
Total bilirubin, μmol/L	16 (10, 27)	16 (11, 27)	-0.067	0.947
CRE, μmol/L	100 (65, 26)	99 (69, 25)	-0.203	0.839
IL-6, pg/mL	104.5 (30.9, 1878.2)	102.5 (38.6, 1507.0)	-0.188	0.851
PCT, ng/mL	1.47 (0.26, 11.75)	1.00 (0.19, 9.26)	-0.594	0.552
ALT, U/L	20.12 (14.00, 40.00)	33.50 (21.00, 71.00)	-3.066	0.002
AST, U/L	27.70 (22.90, 39.61)	49.83 (32.25, 142.12)	-6.148	<0.001
PT, s	13.10 (11.60, 15.50)	14.90 (12.70, 21.30)	-3.772	<0.001
APTT, s	27.90 (26.10, 31.30)	31.20 (28.80, 36.50)	-5.089	<0.001
D-dimer, nmoml/L	1,076 (471.00, 3,427.00)	1,159 (262.75, 5,588.00)	-0.498	0.619
0-h Lac, mmol/L	2.30 (2.00, 4.40)	4.15 (3.03, 6.40)	-6.279	<0.001
6-h Lac, mmol/L	1.50 (1.20, 2.30)	4.15 (2.70, 7.25)	-7.946	<0.001
12-h Lac, mmol/L	1.20 (1.00, 1.98)	2.95 (2.20, 6.20)	-7.835	<0.001
0-h PPI	0.84 (0.60, 1.74)	0.44 (0.27, 0.82)	-4.996	<0.001
6-h PPI	1.92 (0.87, 2.62)	0.76 (0.42, 1.35)	-7.289	<0.001
12-h PPI	3.24 (2.22, 4.08)	0.92 (0.46, 1.53)	-10.727	<0.001
0-6 h Lac clearance rate, %	38.10 (18.44, 54.37)	15.84 (-34.00, 38.62)	-4.926	<0.001
0-12 h Lac clearance rate, %	91.29 (62.96, 142.86)	40.37 (-27.12, 118.59)	-4.450	<0.001
0-6 h PPI change rate, %	61.80 (10.06, 305.48)	36.84 (11.91, 128.67)	-1.715	0.086
0-12 h PPI change rate, %	226.82 (95.12, 605.11)	51.91 (5.52, 193.66)	-5.988	<0.001
Treatment
Fluid volume, mL/d	3,298.26±1,850.21	4,955.48±2,059.30	-5.859	<0.001
Mechanical ventilation	21 (25.00)	91 (78.40)	56.485	<0.001
Vasoactive drugs
NE	25 (29.76)	89 (76.72)	43.839	<0.001
Dose of NE, mg/d	50 (50, 100)	100 (100, 200)	-7.774	<0.001
Dopamine	22 (26.19)	78 (67.24)	32.841	<0.001
Dose of dopamine, mg/d	125 (88, 150)	100 (50, 150)	-1.281	0.200
Dobutamine	1 (1.19)	10 (8.62)	3.844	0.051
Antibiotic
Combination of two drugs	9 (10.71)	5 (4.31)	3.069	0.080
Carbapenem	32 (38.10)	66 (56.90)	6.892	0.009
Quinolone	5 (5.95)	12 (10.34)	1.209	0.272
Cephalosporin	29 (34.52)	26 (22.41)	3.584	0.058
Others	9 (10.71)	7 (6.03)	2.879	0.092

Table 1.

Table 2.

Table 3.

Figure 1.

Figure 2.

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Variables	β	SE	Wald	HR	95% CI	P-value
Age	0.017	0.006	9.485	1.017	1.006-1.029	0.002
GCS score	-0.256	0.038	45.820	0.774	0.718-0.833	<0.001
SOFA score	0.248	0.025	94.654	1.281	1.219-1.347	<0.001
APACHE II score	0.106	0.010	107.473	1.112	1.090-1.134	<0.001
CKD	-0.605	0.305	3.930	1.246	0.800-1.993	0.057
ALT	0.003	0.002	2.665	1.003	0.999-1.007	0.103
AST	0.001	0.001	3.669	1.001	1.000-1.003	0.054
PT	0.035	0.008	20.327	1.035	1.020-1.035	<0.001
APTT	0.010	0.015	45.168	1.015	1.074-1.138	<0.001
Fluid volume, mL/d	0.000	0.000	36.106	1.000	1.000-1.000	<0.001
Dose of NE, mg/d	0.007	0.001	65.880	1.007	1.005-1.009	<0.001
Mechanical ventilation	1.611	0.232	48.405	5.007	3.180-7.882	<0.001
0-h Lac	0.082	0.023	12.436	1.085	1.037-1.136	<0.001
6-h Lac	0.125	0.020	40.194	1.113	1.090-1.178	<0.001
12-h Lac	0.160	0.021	60.350	1.174	1.127-1.222	<0.001
0-h PPI	-0.903	0.184	24.103	0.405	0.282-0.581	<0.001
6-h PPI	-0.921	0.139	44.193	0.398	0.303-0.522	<0.001
12-h PPI	-1.237	0.126	96.614	0.290	0.227-0.371	<0.001

Variables	β	SE	Wald	HR	95% CI	P-value
PT	0.028	0.013	4.647	1.028	1.003-1.054	0.031
6-h PPI	-0.499	0.233	4.596	0.647	0.418-0.985	0.032
12-h PPI	-1.524	0.226	45.475	0.218	0.140-0.339	<0.001

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