Background: This study aimed to evaluated whether using norepinephrine during the management of patients with septic shock impact perfusion index(PI) and patients outcomes.
Methods: We performed a retrospective study among patients with septic shock from January 2014 to December 2018 who had undergone PICCO-plus cardiac output mornitoring and using norepinephrine during the management.We collected basic clinical characteristics.Hemodynamic parameters including lactate,PI and dose of norepinephrine at T0 and 24h after PICCO catheterization (T24) were obtained.We analyzed the effect of perfusion index and norepinephrine on prognosis of patients with septic shock and the correlation between perfusion index and the dose of norepinephrine.
Results: There were 184 patients with septic shock who received during this period, and of these, 44 patients died during their ICU treatment.The PI of the nonsurvivors group was significantly lower than survivors group at T24 (0.5 ± 0.4 vs. 1.5 ± 1.3, P ＜0.001),and the Lac of the nonsurvivors group was significantly higher than the survivors group.In the dose of norepinephrine indicators, we found significantly statistical differences between the two groups at T0 and T24.Dose of norepinephrine and perfusion index were the most independent risk and protective factors for patient ICU mortality. The areas under the curve for a poor prognosis PI were 0.847 (95% CI: 0.782-0.912). The optimal cutoff value of the PI at T24 to predict ICU mortality was 0.6, with a sensitivity of 77.1% and specificity of 80%. Based upon the optimal cutoff value of the PI at T24, we divided patients into groups of PI≥0.6 (n = 125) and PI＜0.6 (n = 59).The Lac of the PI＜0.6 group was higher than the PI≥0.6 group at T24.In the sublingual dose of norepinephrine indicators, the PI＜0.6 group was significantly higher than the PI≥0.6 group.The PI was strong negative correlated with dose of norepinephrine (r = -0.344,P<0.001) and lactate (r = -0.291, P<0.001).
Conclusions: A higher PI is a protective factor and using of higher dose of norepinephrine is a risk factor for the prognosis of critically ill patients with septic shock. Lower PI was associated with the higher dose of norepinephrine.