Author:
Jacquet-Lagrèze Matthias,Pernollet Aymeric,Kattan Eduardo,Ait-Oufella Hafid,Chesnel Delphine,Ruste Martin,Schweizer Rémi,Allaouchiche Bernard,Hernandez Glenn,Fellahi Jean-Luc
Abstract
Abstract
Purpose
Acute circulatory failure leads to tissue hypoperfusion. Capillary refill time (CRT) has been widely studied, but its predictive value remains debated. We conducted a meta-analysis to assess the ability of CRT to predict death or adverse events in a context at risk or confirmed acute circulatory failure in adults.
Method
MEDLINE, EMBASE, and Google scholar databases were screened for relevant studies. The pooled area under the ROC curve (AUC ROC), sensitivity, specificity, threshold, and diagnostic odds ratio using a random-effects model were determined. The primary analysis was the ability of abnormal CRT to predict death in patients with acute circulatory failure. Secondary analysis included the ability of CRT to predict death or adverse events in patients at risk or with confirmed acute circulatory failure, the comparison with lactate, and the identification of explanatory factors associated with better accuracy.
Results
A total of 60,656 patients in 23 studies were included. Concerning the primary analysis, the pooled AUC ROC of 13 studies was 0.66 (95%CI [0.59; 0.76]), and pooled sensitivity was 54% (95%CI [43; 64]). The pooled specificity was 72% (95%CI [55; 84]). The pooled diagnostic odds ratio was 3.4 (95%CI [1.4; 8.3]). Concerning the secondary analysis, the pooled AUC ROC of 23 studies was 0.69 (95%CI [0.65; 0.74]). The prognostic value of CRT compared to lactate was not significantly different. High-quality CRT was associated with a greater accuracy.
Conclusion
CRT poorly predicted death and adverse events in patients at risk or established acute circulatory failure. Its accuracy is greater when high-quality CRT measurement is performed.
Publisher
Springer Science and Business Media LLC
Subject
Critical Care and Intensive Care Medicine
Reference56 articles.
1. Hernandez G, Pedreros C, Veas E, Bruhn A, Romero C, Rovegno M, et al. Evolution of peripheral vs metabolic perfusion parameters during septic shock resuscitation. A Clinical-Physiologic Study J Crit Care. 2012;27:283–8.
2. Jacquet-Lagrèze M, Bouhamri N, Portran P, Schweizer R, Baudin F, Lilot M, et al. Capillary refill time variation induced by passive leg raising predicts capillary refill time response to volume expansion. Crit Care. 2019;23:281.
3. Raia L, Gabarre P, Bonny V, Urbina T, Missri L, Boelle P-Y, et al. Kinetics of capillary refill time after fluid challenge. Ann Intensive Care. 2022;12:74.
4. Guedel AE. Cyclopropane anesthesia. Anesthesiology. 1940;1:13–25.
5. Champion HR, Sacco WJ, Hannan DS, Lepper RL, Atzinger ES, Copes WS, et al. Assessment of injury severity: the triage index. Crit Care Med. 1980;8:201–8.