Hospital IESS-Los Ceibos, Guayaquil, Ecuador.
Eugenio Espejo Specialty Hospital, Quito, Ecuador.
J Intensive Care Med. 2022 Mar;37(3):423-429. doi: 10.1177/08850666211003507. Epub 2021 Mar 26.
Microcirculatory alterations characterize septic shock; increased blood lactate level has been described as markers of microcirculation alteration in patients with septic shock. Although useful, this serological analysis is not always feasible in all settings worldwide.
To determine if a prolonged capillary refilling is a predictor of mortality in patients with septic shock.
A 10-months prospective cohort study was carried out on 175 patients admitted to the Intensive Care Unit (ICU) with the diagnosis of septic shock. The capillary refilling time (CRT) was evaluated Immediately upon admission and after 6 hours post-resuscitation. Traditional tissue perfusion markers were also used to compare and analyze their predictive value on mortality at 28 days.
The area under the ROC curve (AUC) to estimate mortality in patients with septic shock with CRT at admission was 0.666 (0.584-0.748), while at 6 hours was 0.819 (0.753-0.885), with a cut-off point of 4.5 seconds at admission (PPV 52.87% NPV 72.73%) and 3.5 sec at 6 hours (PPV 95.56% NPV 79.23%). In those with CRT > 3.5 seconds at 6 hours, they had a RR of 4.60, while a CRT > 4.5 seconds at admission had a RR of 1.94, with a non-survivor proportion of 95.56% for a CRT > 3.5 sec at 6 hours vs 20.77% for CRT ≤ 3.5 sec ( value < 0.001). The CRT at 6 hours showed significant differences in the survival curves with -value < 0.001, where for values > 3.5 sec, survival at 28 days was 4.44% vs 79.20% for values ≤ 3.5 sec.
CRT is a strong predictor of mortality in patients with septic shock. Evaluating changes in CRT during resuscitation from septic shock might be used as an important clinical tool to predict mortality; especially in low-resources settings where using other biomarkers might be sometimes difficult.
微循环改变是感染性休克的特征；已描述血乳酸水平升高是感染性休克患者微循环改变的标志物。尽管这种血清学分析很有用，但在全球范围内并非所有情况下都可行。
确定毛细血管再充盈时间延长是否可预测感染性休克患者的死亡率。
对入住重症监护病房（ICU）的 175 例诊断为感染性休克的患者进行了为期 10 个月的前瞻性队列研究。在入院时和复苏后 6 小时评估毛细血管再充盈时间（CRT）。还使用了传统的组织灌注标志物来比较和分析它们对 28 天死亡率的预测价值。
入院时 CRT 评估感染性休克患者死亡率的 AUC 为 0.666（0.584-0.748），6 小时时为 0.819（0.753-0.885），入院时 CRT 截断值为 4.5 秒（PPV 52.87%，NPV 72.73%），6 小时时为 3.5 秒（PPV 95.56%，NPV 79.23%）。在 6 小时时 CRT > 3.5 秒的患者中，RR 为 4.60，而入院时 CRT > 4.5 秒的 RR 为 1.94，6 小时时 CRT > 3.5 秒的患者无生存率为 95.56%，而 CRT ≤ 3.5 秒的患者无生存率为 20.77%（<0.001）。6 小时时 CRT 的生存曲线差异有统计学意义（<0.001），对于 CRT > 3.5 秒的患者，28 天的生存率为 4.44%，而 CRT ≤ 3.5 秒的患者为 79.20%。
CRT 是感染性休克患者死亡率的有力预测指标。评估感染性休克复苏过程中 CRT 的变化可能是预测死亡率的重要临床工具；尤其是在资源有限的情况下，使用其他生物标志物有时可能较为困难。
