title: Capillary refill time exploration during septic shock.
abstract: BACKGROUND
  During septic shock management, the evaluation of microvascular perfusion by skin analysis is of interest. We aimed to study the skin capillary refill time (CRT) in a selected septic shock population.
  
  
  METHODS
  We conducted a prospective observational study in a tertiary teaching hospital. After a preliminary study to calculate CRT reproducibility, all consecutive patients with septic shock during a 10-month period were included. After initial resuscitation at 6 h (H6), we recorded hemodynamic parameters and analyzed their predictive value on 14-day mortality. CRT was measured on the index finger tip and on the knee area.
  
  
  RESULTS
  CRT was highly reproducible with an excellent inter-rater concordance calculated at 80% [73-86] for index CRT and 95% [93-98] for knee CRT. A total of 59 patients were included, SOFA score was 10 [7-14], SAPS II was 61 [50-78] and 14-day mortality rate was 36%. CRT measured at both sites was significantly higher in non-survivors compared to survivors (respectively 5.6 ± 3.5 vs 2.3 ± 1.8 s, P < 0.0001 for index CRT and 7.6 ± 4.6 vs 2.9 ± 1.7 s, P < 0.0001 for knee CRT). The CRT at H6 was strongly predictive of 14-day mortality as the area under the curve was 84% [75-94] for the index measurement and was 90% [83-98] for the knee area. A threshold of index CRT at 2.4 s predicted 14-day outcome with a sensitivity of 82% (95% CI [60-95]) and a specificity of 73% (95% CI [56-86]). A threshold of knee CRT at 4.9 s predicted 14-day outcome with a sensitivity of 82% (95% CI [60-95]) and a specificity of 84% (95% CI [68-94]). CRT was significantly related to tissue perfusion parameters such as arterial lactate level and SOFA score. Finally, CRT changes during shock resuscitation were significantly associated with prognosis.
  
  
  CONCLUSIONS
  CRT is a clinical reproducible parameter when measured on the index finger tip or the knee area. After initial resuscitation of septic shock, CRT is a strong predictive factor of 14-day mortality.
authors.affiliation: AP-HP, Hôpital Saint-Antoine, Service de Réanimation Médicale, 184 rue du Faubourg Saint-Antoine, 75571, Paris Cedex 12, France, hafid.aitoufella@sat.aphp.fr.
authors.forename: H
authors.initials: H
authors.lastname: Ait-Oufella
authors.forename: N
authors.initials: N
authors.lastname: Bige
authors.forename: P Y
authors.initials: PY
authors.lastname: Boelle
authors.forename: C
authors.initials: C
authors.lastname: Pichereau
authors.forename: M
authors.initials: M
authors.lastname: Alves
authors.forename: R
authors.initials: R
authors.lastname: Bertinchamp
authors.forename: J L
authors.initials: JL
authors.lastname: Baudel
authors.forename: A
authors.initials: A
authors.lastname: Galbois
authors.forename: E
authors.initials: E
authors.lastname: Maury
authors.forename: B
authors.initials: B
authors.lastname: Guidet
mesh_terms: D000368:Aged; D002196:Capillaries / Q000502:physiology*; D005260:Female; D006801:Humans; D019344:Lactic Acid / Q000097:blood; D008297:Male; D008833:Microcirculation / Q000502:physiology*; D011237:Predictive Value of Tests; D011379:Prognosis; D011446:Prospective Studies; D015203:Reproducibility of Results; D012680:Sensitivity and Specificity; D012720:Severity of Illness Index; D012772:Shock, Septic / Q000401:mortality* / Q000628:therapy; D012867:Skin / Q000098:blood supply*
chemical_list: D019344:Lactic Acid