ABSTRACT
Objective:
To measure the prognostic value of peripheral ischemic microvascular reserve in the context of persistent sepsis-induced hyperlactatemia and measure its influence on the temporal dynamics of lactate and the strength of association between these variables.
Methods:
This post hoc analysis of the peripheral perfusion index/postocclusive reactive hyperemia trial, an observational cohort study that enrolled patients with sepsis who persisted with lactate levels ≥ 2mmol/L after fluid resuscitation (with or without shock). Peripheral ischemic microvascular reserve was evaluated using the association of the peripheral perfusion index and postocclusive reactive hyperemia techniques. The cutoff point of ∆ peripheral perfusion index peak values (%) defined the groups with low (≤ 62%) and high peripheral ischemic microvascular reserve (> 62%).
Results:
A total of 108 consecutive patients with persistent sepsis-induced hyperlactatemia were studied. The high peripheral ischemic microvascular reserve group showed higher 28-day mortality than the low peripheral ischemic microvascular reserve group (p < 0.01). The temporal dynamics of lactate within the first 48 hours showed a rapid decrease in lactate levels in the low peripheral ischemic microvascular reserve group (p < 0.01). However, this result was not reproduced in the linear mixed effects model. A weak correlation between peripheral ischemic microvascular reserve (%) and lactate level (mmol/L) was observed within the first 24 hours (r = 0.23; p < 0.05).
Conclusion:
The prognostic value of high peripheral ischemic microvascular reserve was confirmed in the context of persistent sepsis-induced hyperlactatemia. Although there was a weak positive correlation between peripheral ischemic microvascular reserve value and lactate level within the first 24 hours of sepsis diagnosis, the low peripheral ischemic microvascular reserve group appeared to have a faster decrease in lactate over the 48 hours of follow-up.
Keywords:
Sepsis; Microcirculation; Ischemia; Hyperemia; Perfusion index; Lactate; Prognosis
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PIMR - peripheral ischemic microvascular reserve.
Values depicted are medians and interquartile ranges. Intergroup analysis (low versus high peripheral ischemic microvascular reserve): Day 1 and Day 2 not significant. Intragroup analysis of lactate levels over 48 hours of follow-up: high peripheral ischemic microvascular reserve group not significant; low peripheral ischemic microvascular reserve group; * p < 0.05. Statistical tests: the Mann-Whitney U test (intergroup analyses), the Wilcoxon test (intragroup analyses), and the Bonferroni post hoc test were used for multiple comparisons.PPI - peripheral perfusion index; ∆ PPI peak - variation of peripheral perfusion index peak.
PIMR - peripheral ischemic microvascular reserve.
PIMR - peripheral ischemic microvascular reserve; ∆ PPI peak - variation of peripheral perfusion index peak.