Indian Journal of Critical Care Medicine

Register      Login

SEARCH WITHIN CONTENT

FIND ARTICLE

Volume / Issue

Online First

Archive
Related articles

VOLUME 26 , ISSUE 3 ( March, 2022 ) > List of Articles

Original Article

On Admission, Microcirculation Abnormality is an Independent Predictor of Sepsis and Sepsis-related Mortality: A Hospital-based Study

Anshumalini Panda, Gouroumourty Revadi, Jai P Sharma, Abhijit Pakhare, Abhishek Singhai, Rajnish Joshi, Saurabh Saigal

Keywords : Critically ill adults, Intensivecare, Microcirculation, Sepsis

Citation Information : Panda A, Revadi G, Sharma JP, Pakhare A, Singhai A, Joshi R, Saigal S. On Admission, Microcirculation Abnormality is an Independent Predictor of Sepsis and Sepsis-related Mortality: A Hospital-based Study. Indian J Crit Care Med 2022; 26 (3):294-301.

DOI: 10.5005/jp-journals-10071-24110

License: CC BY-NC 4.0

Published Online: 30-03-2022

Copyright Statement:  Copyright © 2022; The Author(s).


Abstract

Background: Microcirculatory derangement is the primary cause of organ dysfunction in patients with sepsis. Assessment of the microcirculation is usually done by means of indirect parameters (SvO2, transcutaneous PO2, serum lactate). The aim of our study is to understand microcirculatory abnormalities in patients with sepsis by directly visualizing the tiny vessels using hand-held video microscopes (HVMs) and determining the role of this modality in the prediction of sepsis-related mortality. Methods: A longitudinal prospective hospital-based study was carried out in medical ward and ICU of a tertiary care hospital. Patients admitted with the presumed infectious disease were included. Evaluation of sublingual microcirculation was done in these patients from Day 1 to Day 5. Clinical and laboratory variables and microcirculation variables were compared between patients with or without sepsis and between survivors and non-survivors of sepsis. Chi-square test for categorical and Student's t-test or Wilcoxon rank-sum test for continuous variables were applied. Univariate and multivariate regression analyses were performed using the Cox-proportional hazard model. Results and discussion: On admission, microcirculation assessment measure, PPV (small), was significantly reduced in those with sepsis, as compared to those without sepsis. Multivariable models indicate the inverse relationship of PPV small with mortality.


HTML PDF Share
  1. Singer M, Deutschman CS, Seymour CW, Shankar-Hari M, Annane D, Bauer M, et al. The third international consensus definitions for sepsis and septic shock (sepsis-3). Journal of the American Medical Association 2016;315(8):801–810. DOI: 10.1001/jama. 2016.0287.
  2. Rhodes A, Evans LE, Alhazzani W, Levy MM, Antonelli M, Ferrer R, et al. Surviving sepsis campaign: international guidelines for management of sepsis and septic shock—2016. Crit Care Med 2017;45(3):486–552. DOI: 10.1097/CCM.0000000000002255.
  3. Rudd KE, Johnson SC, Agesa KM, Shackelford KA, Tsoi D, Kievlan DR, et al. Global, regional, and national sepsis incidence and mortality, 1990-2017: analysis for the Global Burden of Disease Study. Lancet 2020;395(10219):200–211. DOI: 10.1016/S0140-6736(19)32989-7.
  4. Rudd KE, Kissoon N, Limmathurotsakul D, Bory S, Mutahunga B, Seymour CW, et al. The global burden of sepsis: barriers and potential solutions. Crit Care 2018;22(1):232. DOI: 10.1186/s13054-018-2157-z.
  5. De Backer D. Is microcirculatory assessment ready for regular use in clinical practice? Curr Opin Crit Care 2019;25(3):280–284. DOI: 10.1097/MCC.0000000000000605.
  6. Pranskunas A, Pilvinis V, Dambrauskas Z, Rasimaviciute R, Planciuniene R, Dobozinskas P, et al. Early course of microcirculatory perfusion in eye and digestive tract during hypodynamic sepsis. Crit Care 2012;16(3):R83. DOI: 10.1186/cc11341.
  7. Sharawy N, Mahrous R, Whynot S, George R, Lehmann C. Clinical relevance of early sublingual microcirculation monitoring in septic shock patients. Clin Hemorheol Microcirc 2018;68(4):347–359. DOI: 10.3233/CH-170244.
  8. Naumann DN, Mellis C, Husheer SL, Hopkins P, Bishop J, Midwinter MJ, et al. Real-time point of care microcirculatory assessment of shock: design, rationale and application of the point of care microcirculation (POEM) tool. Crit Care 2016;20(1):310. DOI: 10.1186/s13054-016-1492-1.
  9. De Backer D, Hollenberg S, Boerma C, Goedhart P, Büchele G, Ospina-Tascon G, et al. How to evaluate the microcirculation: report of a round table conference. Crit Care 2007;11(5):R101. DOI: 10.1186/cc6118.
  10. Pan P, Liu DW, Su LX, He HW, Wang XT, Yu C. Role of combining peripheral with sublingual perfusion on evaluating microcirculation and predicting prognosis in patients with septic shock. Chin Med J (Engl) 2018;131(10):1158–1166. DOI: 10.4103/0366-6999.231524.
  11. Sallisalmi M, Oksala N, Pettilä V, Tenhunen J. Evaluation of sublingual microcirculatory blood flow in the critically ill. Acta Anaesthesiol Scand 2012;56(3):298–306. DOI: 10.1111/j.1399-6576.2011.02569.x.
  12. Ince C, Boerma EC, Cecconi M, De Backer D, Shapiro NI, Duranteau J, et al. Second consensus on the assessment of sublingual microcirculation in critically ill patients: results from a task force of the European Society of Intensive Care Medicine. Intensive Care Med 2018;44(3):281–299. DOI: 10.1007/s00134-018-5070-7.
  13. Cox D. Regression models and life-tables. J R Stat Soc Ser B (Methodological) 1972;34(2):187–220. DOI: 10.1007/978-1-4612-4380-9_37 [Retrieved June 23, 2021]. Available from: http://www.jstor.org/stable/2985181.
  14. Trzeciak S, McCoy JV, Phillip Dellinger R, Arnold RC, Rizzuto M, Abate NL, et al. Microcirculatory Alterations in Resuscitation and Shock (MARS) investigators. Early increases in microcirculatory perfusion during protocol-directed resuscitation are associated with reduced multi-organ failure at 24 h in patients with sepsis. Intensive Care Med 2008;34(12):2210–2217. DOI: 10.1007/s00134-008- 1193-6.
  15. Potter EK, Hodgson L, Creagh-Brown B, Forni LG. Manipulating the microcirculation in sepsis – the impact of vasoactive medications on microcirculatory blood flow: a systematic review. Shock 2019;52(1): 5–12. DOI: 10.1097/SHK.0000000000001239.
  16. Pinheiro TT, de Freitas FGR, Coimbra KTF, Mendez VMF, Rossetti HB, Talma PV, et al. Short-term effects of passive mobilization on the sublingual microcirculation and on the systemic circulation in patients with septic shock. Ann Intensive Care 2017;7(1):95. DOI: 10.1186/s13613-017-0318-x.
  17. González R, López J, Urbano J, Solana MJ, Fernández SN, Santiago MJ, et al. Evaluation of sublingual microcirculation in a paediatric intensive care unit: prospective observational study about its feasibility and utility. BMC Pediatr 2017;17(1):75. DOI: 10.1186/s12887-017-0837-5.
PDF Share
PDF Share

© Jaypee Brothers Medical Publishers (P) LTD.