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Observational Study
. 2020 Oct 14;15(10):e0239770.
doi: 10.1371/journal.pone.0239770. eCollection 2020.

Monitoring peripheral perfusion in sepsis associated acute kidney injury: Analysis of mortality

Ana Carolina de Miranda  1 , Igor Alexandre Cortês de Menezes  1 , Hipolito Carraro Junior  2 , Alain Márcio Luy  2 , Marcelo Mazza do Nascimento  1
Affiliations
Observational Study

Monitoring peripheral perfusion in sepsis associated acute kidney injury: Analysis of mortality

Ana Carolina de Miranda et al. PLoS One. .

Abstract

Microcirculatory disorders have been consistently linked to the pathophysiology of sepsis. One of the major organs affected is the kidneys, resulting in sepsis-associated acute kidney injury (SA-AKI) that correlates considerably with mortality. However, the potential role of clinical assessment of peripheral perfusion as a possible tool for SA-AKI management has not been established. To address this gap, the purpose of this study was to investigate the prevalence of peripheral hypoperfusion in SA-AKI, its association with mortality, and fluid balance. This observational cohort study enrolled consecutive septic patients in the Intensive Care Unit. After fluid resuscitation, peripheral perfusion was evaluated using the capillary filling time (CRT) and peripheral perfusion index (PI) techniques. The AKI was defined based on both serum creatinine and urine output criteria. One hundred and forty-one patients were included, 28 (19%) in the non-SA-AKI group, and 113 (81%) in the SA-AKI group. The study revealed higher peripheral hypoperfusion rates in the SA-AKI group using the CRT (OR 3.6; 95% CI 1.35-9.55; p < 0.05). However, this result lost significance after multivariate adjustment. Perfusion abnormalities in the SA-AKI group diagnosed by both CRT (RR 1.96; 95% CI 1.25-3.08) and PI (RR 1.98; 95% CI 1.37-2.86) methods were associated to higher rates of 28-day mortality (p < 0.01). The PI's temporal analysis showed a high predictive value for death over the first 72 h (p < 0.01). A weak correlation between PI values and the fluid balance was found over the first 24 h (r = - 0.20; p < 0.05). In conclusion, peripheral perfusion was not different intrinsically between patients with or without SA-AKI. The presence of peripheral hypoperfusion in the SA-AKI group has appeared to be a prognostic marker for mortality. This evaluation maintained its predictive value over the first 72 hours. The fluid balance possibly negatively influences peripheral perfusion in the SA-AKI.

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Conflict of interest statement

The authors have declared that no competing interests exist.

Figures

Fig 1
Fig 1. Flow-chard of study.
Fig 2
Fig 2. Prevalence of peripheral hypoperfusion after fluid resuscitation between SA-AKI and non-SA-AKI groups.
(A) Peripheral Perfusion Index ns (B) Capillary Refill Time *p < 0.05.
Fig 3
Fig 3. The 28-day in-hospital mortality rates associated with peripheral hypoperfusion in the SA-AKI group.
(A) Peripheral perfusion index **p < 0.01; (B) Capillary Refill Time **p < 0.01.
Fig 4
Fig 4. Prognostic significance of PI’s values over the first 72 hours in the SA-AKI group.
(A) Group and time interaction analyses ns (B) Intragroup analyses ns (C) Intergroups analyses (survivors and nonsurvivors) **p < 0.01.
Fig 5
Fig 5. Correlation between fluid balance and PI’s values within 24 h of sepsis diagnosis in the SA-AKI group.
*p < 0.05.
See this image and copyright information in PMC

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