The value of proportion of perfused vessels change rate in the evaluation of early organ function deterioration in septic shock and ARDS

TL;DR

This study shows that changes in microcirculation, measured by ΔPPV, can help predict early organ failure in patients with septic shock and ARDS.

Contribution

A predictive model using ΔPPV and lactate clearance rate for early organ function deterioration in septic shock and ARDS patients is proposed.

Findings

ΔPPV and lactate clearance rate were independently associated with early organ function deterioration.

Combining ΔPPV and lactate clearance rate improved the model's predictive accuracy (AUC of 0.871).

Early organ function deterioration is common in septic shock and ARDS patients.

Abstract

Severe organ function deterioration is associated with poor prognosis in patients with septic shock combined with ARDS. This study aimed to develop a validated predictive model for early organ function deterioration and to evaluate the factors associated with this deterioration, as well as the prognosis, in patients with septic shock combined with ARDS.

This is a retrospective study including 67 patients with septic shock combined with ARDS. Patients were categorized into two groups based on the change in their Sequential Organ Failure Assessment (SOFA) score over 24 h: the organ function deterioration group (SOFA24h − 0h score ≥ 1) and the non-deterioration group (SOFA24h − 0h score <1). The sublingual microvasculature of patients was assessed using microcirculatory microimaging to obtain metrics such as proportion of perfusion vessel change rate (ΔPPV), which were then analyzed to characterize the patients with early organ function deterioration.

There were a total of 34 patients with early organ function deterioration. ΔPPV and LCR were independently associated with early organ function deterioration, and ΔPPV and lactate clearance rate (LCR) were associated with ΔSOFA. The AUC for ΔPPV was 0.813 (95% CI: 0.707–0.919), and when combined with the LCR, the AUC was 0.871 (95% CI: 0.785–0.957).

Deterioration of organ function is common in patients with septic shock combined with ARDS and early detection is crucial. Microcirculation is an important factor in safeguarding organ function. We developed a predictive model to predict the risk of early organ function deterioration, and the combination of ΔPPV and LCR may merit further investigation.

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