Hospices Civils de Lyon, Centre Hospitalier Lyon-Sud, Service de Réanimation, Pierre-Bénite F-69310, France; Université Claude Bernard, Lyon1, Villeurbanne, France.
Hospices Civils de Lyon, Centre Hospitalier Lyon-Sud, Service de Réanimation, Pierre-Bénite F-69310, France; Université Claude Bernard, Lyon1, Villeurbanne, France; Service de Biostatistique-Bioinformatique, Pôle Santé Publique, Hospices Civils de Lyon, Lyon, France.
J Crit Care. 2020 Dec;60:294-299. doi: 10.1016/j.jcrc.2020.08.022. Epub 2020 Sep 2.
Septic shock is associated with altered peripheral perfusion. Core-to-skin temperature gradient depends on skin perfusion and microcirculatory function. We hypothesized that a high core-to-skin temperature gradient is correlated with mortality in septic shock.
We conducted a prospective observational study including 61 patients at the first 24 h of a septic shock in an intensive care unit. During the 24 first hours after norepinephrine administration, we collected clinical and circulatory characteristics, skin perfusion assessment (Capillary refill time (CRT), Mottling score) and we measured skin temperature with an infrared thermographic camera. We measured the Core-to-skin temperature gradient to evaluate if it is a predictor of day-8 mortality.
Day-8 mortality was 16.3%. Core-to-index finger temperature gradient >7 °C was associated with day-8 mortality (OR = 18.0, [3.02-346.14], p = 0.002). This association was still significant after adjustment to the SOFA (Sequential Organ Failure Assessment) score. A model including a high SOFA score and a core-to index finger >7 °C was effective to predict day-8 mortality (c-statistic: 0.8735 [0.770-0.976]). Core-to-index finger temperature gradient was correlated with CRT, Mottling Score, and arterial lactate levels.
Core-to-index finger temperature gradient higher than 7 °C predicts day-8 mortality in septic shock and is correlated with other tissue perfusion markers.
感染性休克与外周灌注改变有关。核心到皮肤的温度梯度取决于皮肤灌注和微循环功能。我们假设高核心到皮肤的温度梯度与感染性休克的死亡率相关。
我们进行了一项前瞻性观察性研究，纳入了 61 例在重症监护病房发生感染性休克的患者。在去甲肾上腺素给药后的 24 小时内，我们收集了临床和循环特征、皮肤灌注评估（毛细血管再充盈时间（CRT）、斑驳评分），并用红外热像仪测量了皮肤温度。我们测量了核心到皮肤的温度梯度，以评估其是否是第 8 天死亡率的预测指标。
第 8 天死亡率为 16.3%。核心到食指的温度梯度>7°C与第 8 天的死亡率相关（OR=18.0，[3.02-346.14]，p=0.002）。在调整序贯器官衰竭评估（SOFA）评分后，这种相关性仍然显著。包括高 SOFA 评分和核心到食指>7°C 的模型能够有效地预测第 8 天的死亡率（c 统计量：0.8735 [0.770-0.976]）。核心到食指的温度梯度与 CRT、斑驳评分和动脉乳酸水平相关。
核心到食指的温度梯度高于 7°C 预测感染性休克第 8 天的死亡率，并与其他组织灌注标志物相关。
