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Meta-Analysis
. 2023 Dec 2;27(1):473.
doi: 10.1186/s13054-023-04751-9.

Prognostic value of capillary refill time in adult patients: a systematic review with meta-analysis

Matthias Jacquet-Lagrèze  1   2   3 , Aymeric Pernollet  4   5 , Eduardo Kattan  6   7 , Hafid Ait-Oufella  8 , Delphine Chesnel  4   5 , Martin Ruste  4   5   9 , Rémi Schweizer  4   5 , Bernard Allaouchiche  5   10 , Glenn Hernandez  6   7 , Jean-Luc Fellahi  4   5   9
Affiliations
Meta-Analysis

Prognostic value of capillary refill time in adult patients: a systematic review with meta-analysis

Matthias Jacquet-Lagrèze et al. Crit Care. .

Abstract

Purpose: Acute circulatory failure leads to tissue hypoperfusion. Capillary refill time (CRT) has been widely studied, but its predictive value remains debated. We conducted a meta-analysis to assess the ability of CRT to predict death or adverse events in a context at risk or confirmed acute circulatory failure in adults.

Method: MEDLINE, EMBASE, and Google scholar databases were screened for relevant studies. The pooled area under the ROC curve (AUC ROC), sensitivity, specificity, threshold, and diagnostic odds ratio using a random-effects model were determined. The primary analysis was the ability of abnormal CRT to predict death in patients with acute circulatory failure. Secondary analysis included the ability of CRT to predict death or adverse events in patients at risk or with confirmed acute circulatory failure, the comparison with lactate, and the identification of explanatory factors associated with better accuracy.

Results: A total of 60,656 patients in 23 studies were included. Concerning the primary analysis, the pooled AUC ROC of 13 studies was 0.66 (95%CI [0.59; 0.76]), and pooled sensitivity was 54% (95%CI [43; 64]). The pooled specificity was 72% (95%CI [55; 84]). The pooled diagnostic odds ratio was 3.4 (95%CI [1.4; 8.3]). Concerning the secondary analysis, the pooled AUC ROC of 23 studies was 0.69 (95%CI [0.65; 0.74]). The prognostic value of CRT compared to lactate was not significantly different. High-quality CRT was associated with a greater accuracy.

Conclusion: CRT poorly predicted death and adverse events in patients at risk or established acute circulatory failure. Its accuracy is greater when high-quality CRT measurement is performed.

Keywords: Acute circulatory failure; Capillary refill time; Microcirculation; Septic shock.

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Conflict of interest statement

MJL is cofounder and shareholder of the DiCARTECH company that has been created to build and sell a device that measure capillary refill time.

Figures

Fig. 1
Fig. 1
Flowchart of the meta-analysis selection process. CRT Capillary refill time
Fig. 2
Fig. 2
Light plot QUADAS evaluation of risk of bias of each study
Fig. 3
Fig. 3
QUADAS assessment of risk of bias and applicability concern. Proportions of studies with low, unclear, and high risk of bias (A) or applicability concern (B) according to each item of the QUADAS evaluation
Fig. 4
Fig. 4
Diagnostic odds ratio of individual study and pooled odds ratio using a random effect model
See this image and copyright information in PMC

References

    1. Hernandez G, Pedreros C, Veas E, Bruhn A, Romero C, Rovegno M, et al. Evolution of peripheral vs metabolic perfusion parameters during septic shock resuscitation. A Clinical-Physiologic Study J Crit Care. 2012;27:283–288. - PubMed
    1. Jacquet-Lagrèze M, Bouhamri N, Portran P, Schweizer R, Baudin F, Lilot M, et al. Capillary refill time variation induced by passive leg raising predicts capillary refill time response to volume expansion. Crit Care. 2019;23:281. doi: 10.1186/s13054-019-2560-0. - DOI - PMC - PubMed
    1. Raia L, Gabarre P, Bonny V, Urbina T, Missri L, Boelle P-Y, et al. Kinetics of capillary refill time after fluid challenge. Ann Intensive Care. 2022;12:74. doi: 10.1186/s13613-022-01049-x. - DOI - PMC - PubMed
    1. Guedel AE. Cyclopropane anesthesia. Anesthesiology. 1940;1:13–25. doi: 10.1097/00000542-194007000-00002. - DOI
    1. Champion HR, Sacco WJ, Hannan DS, Lepper RL, Atzinger ES, Copes WS, et al. Assessment of injury severity: the triage index. Crit Care Med. 1980;8:201–208. doi: 10.1097/00003246-198004000-00001. - DOI - PubMed