Peripheral ischemic reserve in sepsis and septic shock as a new bedside prognostic enrichment tool: A Brazilian cohort study

Figures

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  Fig 1. Assessment of PIMR assessed by the association between PPI/PORH methods. PIMR = peripheral ischemic microvascular reserve. PPI = Peripheral ischemic index. PORH = Post-occlusive reactive hyperemia.

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  Fig 2. Flow chart of the study showing the group allocation based on the PIMR value (See Methods). PIMR = peripheral ischemic microvascular reserve.

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  Fig 3. The 28-day in-hospital mortality rates in septic patients with high (> 62%) and low (< 62%) ΔPPI peak values. The numbers above bars are deaths/N of the respective group. * Significant difference between groups p = 0.04. High PIMR group N = 109. Low PIMR group N = 117. ΔPPI peak = variation of the peripheral perfusion index peak. PIMR = peripheral ischemic microvascular reserve.

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  Fig 4. The 28-day in-hospital mortality rates in septic patients with high (> 62%) and low (< 62%) ΔPPI peak values in septic shock (Panel A) and sepsis without shock (Panel B). Septic shock patients N = 70. Sepsis without shock patients N = 156. The numbers above bars are deaths/N of the respective group. (A) * Significant difference between groups p = 0.01 using the Fisher’s test. (B) No significant difference between groups was observed for the sepsis without shock group p = 0.73. ΔPPI peak = variation of the peripheral perfusion index peak.

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  Fig 5. Temporal evaluation of the prognostic value of ΔPPI peak value in patients with sepsis. Patients with sepsis N = 226. Survivors in 28 days of follow-up N = 136. Nonsurvivors in 28 days of follow-up N = 90. Values are expressed as median/IQR. Intergroup analysis (survivors vs. nonsurvivors): Day 1* p = 0.01 and Day 2 p = 0.31. Intragroup analysis over 48 h: Survivors p = 0.52; Nonsurvivors * p = 0.02. Statistical tests: Mann-Whitney U test (intergroup analyses), the Wilcoxon test (intragroup analyses), and the Bonferroni post hoc test were used for multiple comparisons. ΔPPI peak = variation of the peripheral perfusion index peak.

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  Fig 6. Temporal evaluation of the prognostic value of ΔPPI peak value in patients with septic shock. Septic shock patients N = 70. Survivors in 28 days of follow-up N = 29. Nonsurvivors in 28 days of follow-up N = 41. Intergroup analysis (survivors vs. nonsurvivors): Day 1* p = 0.03 and Day 2 p = 0.56. Intragroup analysis over 48 h: Survivors p = 0.72; Nonsurvivors p = 0.12. Statistical tests: Mann-Whitney U test (intergroup analyses), the Wilcoxon test (intragroup analyses), and the Bonferroni post hoc test were used for multiple comparisons. ΔPPI peak = variation of the peripheral perfusion index peak.

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  Fig 7. Correlation between ΔPPI peak (%) and CRT (s) values within 24 h of sepsis diagnosis. **p < 0.01. Statistical test: Spearman test. Patients with sepsis N = 226. ΔPPI peak = variation of the peripheral perfusion index peak. CRT = Capillary refill time.