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Observational Study
. 2024 Oct;37(5):401-408.
doi: 10.37201/req/029.2024. Epub 2024 Jun 28.

Use of noninvasive measurement of the indocyanine green plasma disappearance rate in patients with septic shock

I Gutiérrez-Morales  1 , A Loza-Vázquez, J A Sánchez-Román, A Grilo-Reina, M A Navarro-Puerto
Affiliations
Observational Study

Use of noninvasive measurement of the indocyanine green plasma disappearance rate in patients with septic shock

I Gutiérrez-Morales et al. Rev Esp Quimioter. 2024 Oct.

Abstract
in English, Spanish

Objective: Our aim was to analyse the relation between serial values of the indocyanine green plasma disappearance rate (ICG-PDR) with hospital mortality in the first 48 hours of ICU admission in patients with septic shock.

Methods: A prospective observational study was carried out over 12 months of patients admitted to the ICU with septic shock. Each patient underwent noninvasive determination of ICG-PDR at 24 and 48 hours with the LiMON® module. Follow-up was performed until hospital discharge or exitus.

Results: 63 patients. Age 61.1±12.3 years. 60.3% men. SOFA score on admission 8.7±3.3, APACHE II score was 27.9±10.7 points. A total of 44.4% of patients died. The ICG-PDR values in the first 24 hours of ICU admission were lower in nonsurvivors: 10.5 (5.7-13.0)%/min vs. 15.9 (11.4-28.0)%/min, p <0.001. Furthermore, in nonsurvivors, there was no improvement in ICG-PDR between 24 h and 48 h, while in survivors, there was an increase of 25%: 15.9 (11.4-28.0)%/min and 20.9 (18.0-27.0)%/min, p=0.020. The silhouette measure of ICG-PDR cohesion and separation for the clusters analysed (nonsurvivors and survivors) was satisfactory (0.6). ICG-PDR<11.7%/min was related to in-hospital mortality, ICG-PDR> 18%/min to survival, and the interval between 11.7% and 18%/min covered a range of uncertainty. In the two-stage cluster, ICG-PDR, SOFA and APACHE II present satisfactory predictive scores 24 hours after patient admission.

Conclusions: ICG-PDR in our setting is a useful clinical prognostic tool and could optimise the decision tree in patients with septic shock.

Introducción: Nuestro objetivo fue analizar la relación de los valores seriados de la tasa de desaparición plasmática de verde de indocianina (ICG-PDR) con la mortalidad hospitalaria en las primeras 48 horas de ingreso en UCI en pacientes con shock séptico.

Métodos: Estudio observacional prospectivo durante 12 meses en pacientes de UCI con shock séptico. Cada paciente se sometió a la determinación no invasiva de ICG-PDR a las 24 y 48 horas con el módulo LiMON®. El seguimiento se realizó hasta el alta hospitalaria o el fallecimiento.

Resultados: 63 pacientes. Edad 61,1±12,3 años. 60,3% hombres. SOFA al ingreso 8,7±3,3, APACHE II 27,9±10,7 puntos. Un 44,4% de los pacientes falleció. Los valores de ICG-PDR en las primeras 24 horas de ingreso a la UCI fueron más bajos en los no supervivientes: 10,5 (5,7-13,0)%/min vs. 15,9 (11,4-28,0)%/min, p <0,001. Además, en los no supervivientes, no hubo mejora en ICGPDR entre las 24 y 48 horas, mientras que en los supervivientes hubo un aumento del 25%: 15,9 (11,4-28,0)%/min y 20,9 (18,0-27,0)%/min, p=0,020. La medida de la silueta de la cohesión y separación de ICG-PDR para los grupos analizados (no supervivientes y supervivientes) fue satisfactoria (0,6). ICG-PDR<11,7%/min se relacionó con la mortalidad intrahospitalaria, ICG-PDR>18%/ min con la supervivencia y el intervalo entre 11,7% y 18%/min abarcaba un rango de incertidumbre. En el clúster bietápico, ICGPDR, SOFA y APACHE II presentan puntuaciones predictoras satisfactorias a las 24 horas del ingreso del paciente.

Conclusiones: ICG-PDR en nuestro entorno es una herramienta pronóstica clínica útil y podría optimizar el árbol de decisiones en pacientes con shock séptico.

Keywords: ICU; Indocyanine green; Septic shock.

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Conflict of interest statement

Authors declare no conflict of interest.

Figures

Figure 1
Figure 1
Flow diagram of patients included in the study.
Figure 2
Figure 2
Box plot of the evolution of ICG-PDR (%/min) in the groups of survivors and nonsurvivors with septic shock. ICG-PDR: indocyanine green plasma disappearance rate.
Figure 3
Figure 3
ICG-PDR score ranges (%/min) according to mortality or survival at 24 and 48 hours of admission in patients with septic shock. Red: mortality; green: survival; yellow: range of uncertainty. ICG-PDR: indocyanine green plasma disappearance rate.
See this image and copyright information in PMC

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