Prognostic value of peripheral perfusion index combined with plasma volume in patients with septic shock

doi:10.11958/20252220

Abstract

Abstract:

Objective To evaluate the value of peripheral perfusion index (PPI) combined with plasma volume (PV) in the 28-day prognosis of patients with septic shock. Methods A total of 150 septic shock patients were divided into two groups based on their 28-day survival status: the death group (n=52) and the survival group (n=98). The general information, laboratory test results within 6 hours of admission, Sequential Organ Failure Assessment (SOFA) score, Acute Physiology and Chronic Health Evaluation II (APACHE II) score, PPI and PV were compared between the two groups. The Cox proportional hazards regression model was used to analyze the influencing factors of patient mortality, and the receiver operating characteristic (ROC) curve was used to analyze the predictive value of PPI and PV for patient mortality. The 28-day mortality rates of patients with PPI and PV at different levels were compared using the Kaplan-Meier curve. Results Compared with the survival group, patients in the death group were significantly older, with increased SOFA score, APACHE Ⅱ scores, hematocrit (HCT), and decreased PPI and PV values (all P<0.05). Cox proportional hazards regression analysis revealed that older age (HR=1.033, 95%CI: 1.011-1.055), elevated SOFA score (HR=1.186, 95%CI: 1.050-1.339) and increased APACHE Ⅱ score (HR=1.137, 95%CI:1.079-1.197) were independent risk factors for 28-day mortality in patients with septic shock. In contrast, PPI (HR=0.136, 95%CI: 0.062-0.296) and PV (HR=0.904, 95%CI: 0.858-0.951) served as independent protective factors against 28-day mortality (all P<0.05). Based on optimal cut-off values, patients were stratified into the high PPI group (≥1.60, n=78), the low PPI group (<1.60, n=72), the high PV group (≥38.5 mL/kg, n=69) and the low PV group (<38.5 mL/kg, n=81). Kaplan-Meier survival analysis demonstrated significantly higher cumulative 28-day survival rates in the high PPI group and the high PV group compared with their respective low-value groups (all P<0.05). ROC curve analysis showed that the combined use of PPI and PV yielded an AUC of 0.953 (95%CI: 0.923-0.983) for predicting 28-day mortality in septic shock patients, with a sensitivity of 88.46% and specificity of 88.78% (all P<0.05). Conclusion The combination of PPI and PV has significant value in predicting the prognosis of patients with septic shock and can provide strong evidence for clinical treatment decision.

Key words: shock, septic, plasma volume, peripheral perfusion index, 28 d prognosis

CLC Number:

R631.4，R364.19

Figures/Tables 7

References 19

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组别	n		年龄/岁		男性	BMI/（kg/m²）		高血压史		糖尿病史		MAP/ mmHg		ALT/（U/L）		AST/（U/L）		Cr/（μmol/L）		BUN/（mmol/L）
存活组	98		63.67±10.66		59（60.2）	20.42±1.49		49（50.0）		37（37.8）		68.63±2.47		22.33±1.72		30.98±2.38		98.62±7.09		6.39±2.38
死亡组	52		78.35±12.33		30（57.7）	20.36±1.47		28（53.9）		22（42.3）		68.42±2.33		22.45±1.36		30.55±2.63		98.47±6.77		6.66±2.45
t或χ²			7.597^＊＊		0.089	0.236		0.201		0.295		0.505		0.436		1.015		0.125		0.655
组别		Lac/（mmol/L）		PCT/ （μg/L）			IL-6/ （ng/L）		PT/s		INR		HCT/%		SOFA/分		APACHE Ⅱ/分		PPI		PV/ （mL/kg）
存活组		4.35±1.08		10.56±1.83			118.56±38.52		11.23±1.44		0.95±0.15		33.53±1.12		10.38±2.45		10.40±3.20		1.80±0.25		41.35±4.26
死亡组		4.22±1.26		10.65±1.81			110.36±30.26		11.26±1.25		0.96±0.13		43.48±1.24		15.33±1.72		18.52±3.24		1.40±0.27		35.59±4.22
t		0.662		0.288			1.332		0.127		0.406		49.878^＊＊		12.963^＊＊		14.727^＊＊		9.069^＊＊		7.907^＊＊

组别	n		年龄/岁		男性	BMI/（kg/m²）		高血压史		糖尿病史		MAP/ mmHg		ALT/（U/L）		AST/（U/L）		Cr/（μmol/L）		BUN/（mmol/L）
存活组	98		63.67±10.66		59（60.2）	20.42±1.49		49（50.0）		37（37.8）		68.63±2.47		22.33±1.72		30.98±2.38		98.62±7.09		6.39±2.38
死亡组	52		78.35±12.33		30（57.7）	20.36±1.47		28（53.9）		22（42.3）		68.42±2.33		22.45±1.36		30.55±2.63		98.47±6.77		6.66±2.45
t或χ²			7.597^＊＊		0.089	0.236		0.201		0.295		0.505		0.436		1.015		0.125		0.655
组别		Lac/（mmol/L）		PCT/ （μg/L）			IL-6/ （ng/L）		PT/s		INR		HCT/%		SOFA/分		APACHE Ⅱ/分		PPI		PV/ （mL/kg）
存活组		4.35±1.08		10.56±1.83			118.56±38.52		11.23±1.44		0.95±0.15		33.53±1.12		10.38±2.45		10.40±3.20		1.80±0.25		41.35±4.26
死亡组		4.22±1.26		10.65±1.81			110.36±30.26		11.26±1.25		0.96±0.13		43.48±1.24		15.33±1.72		18.52±3.24		1.40±0.27		35.59±4.22
t		0.662		0.288			1.332		0.127		0.406		49.878^＊＊		12.963^＊＊		14.727^＊＊		9.069^＊＊		7.907^＊＊

指标	β	SE	Wald χ²	P	HR	HR 95%CI
年龄	0.032	0.011	8.725	0.004	1.033	1.011~1.055
SOFA评分	0.170	0.060	7.592	0.005	1.186	1.050~1.339
APACHEⅡ评分	0.128	0.027	23.317	<0.001	1.137	1.079~1.197
PPI	-1.997	0.398	25.187	<0.001	0.136	0.062~0.296
PV	-0.101	0.026	14.890	<0.001	0.904	0.858~0.951

指标	β	SE	Wald χ²	P	HR	HR 95%CI
年龄	0.032	0.011	8.725	0.004	1.033	1.011~1.055
SOFA评分	0.170	0.060	7.592	0.005	1.186	1.050~1.339
APACHEⅡ评分	0.128	0.027	23.317	<0.001	1.137	1.079~1.197
PPI	-1.997	0.398	25.187	<0.001	0.136	0.062~0.296
PV	-0.101	0.026	14.890	<0.001	0.904	0.858~0.951

指标	AUC（95%CI）	最佳截断值	敏感度/ %	特异度/ %	约登指数
年龄	0.833（0.763~0.903）	70岁	75.00	80.61	0.556
SOFA	0.643（0.555~0.731）	10分	90.38	31.63	0.220
APACHEⅡ	0.841（0.777~0.906）	14分	78.85	75.53	0.544
PPI	0.917（0.872~0.963）	1.60	82.31	86.73	0.692
PV	0.843（0.769~0.917）	38.5 mL/kg	69.23	91.84	0.611
PPI+PV	0.953（0.923~0.983）	-	88.46	88.78	0.772