The receiver operator characteristic curve showed the StO2 reperf

The receiver operator characteristic curve showed the StO2 reperfusion slope as a good outcome predictor (area under the curve = 0.77). The best cut-off value was 2.83%/second, with a sensitivity of 80% and a specificity of 67%. In addition, using a multivariable model, the StO2 reperfusion slope added a significant prognostic value both to the SOFA score (P = 0.037) (Figure (Figure5)5) and to the Simplified Acute Physiology Score II (P = 0.015) (data not shown).Figure 5Predictive value on outcome. Area under the curve (AUC) for the multivariate model using each determinant alone or in combination (solid curve). Se, sensitivity; SOFA, Sequential Organ Failure Assessment; Sp, specificity.Laser Doppler dataFifteen (34.8%) out of the 43 septic shock patients were also evaluated with the skin LD technique.

Values obtained for the total group were: baseline, 2.74 TPU (1.92 to 5.65) (normal values �� standard deviation: 30.49 �� 21.30); peak value during the hyperemic phase, 6.67 TPU (5.02 to 9.3); peak value-baseline difference, 3.62 TPU (1.88 to 4.58); reper-fusion slope, 1.16 TPU/second (0.49 to 2.64) (normal values �� standard deviation: 48.62 �� 32.08). There were no significant differences in these parameters between survivors and nonsurvivors (data not shown). The LD reperfusion slope tended to correlate with the StO2 reperfusion slope, but did not reach statistical significance (P = 0.08) (Figure (Figure4d4d).DiscussionThis prospective, observational study follows the recently published study by Creteur and colleagues on severe sepsis and septic shock using the same device [22].

The primary new inputs of our study design are the selection of a very homogeneous population (that is, only septic shock patients having at least one additional organ failure), two techniques for microperfusion assessment (StO2 and skin LD), a day 1 evaluation of the predictive value of the reperfusion slope with a clear difference in median between survivors and non-survivors, and an investigation of the potential determinants of the reperfusion slope (systemic hemodynamic and metabolic parameters such as lactate and the occlusion slope). Our StO2 parameters in septic shock confirm the observations made by Creteur and colleagues in septic shock: the muscle baseline StO2 is slightly lower in septic shock patients than in healthy controls; and only the StO2 reperfusion slope and not the occlusion slope is slower in septic shock than in healthy controls.

In addition, the StO2 reperfusion slope was lower at day 1 in nonsurvivors than in survivors and predicted outcome within 28 days. The LD data, although abnormal, did not correlate well with StO2 parameters. Dacomitinib The link between systemic hemodynamic or metabolic parameters with the StO2 reperfusion slope suggests an impact on tissue micro-oxygenation, even if their respective role cannot be precisely determined.

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