Prolonged Capillary Refill Time Linked to Adverse Outcomes in Sepsis-Related Hyperlactatemia

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Prolonged capillary refill time has been associated with increased morbidity and mortality.
Prolonged capillary refill time has been associated with increased morbidity and mortality.

Among patients with sepsis-related hyperlactatemia, abnormal capillary refill time (CRT) was shown to be associated with higher mortality and worse clinical outcomes compared with normal CRT, according to the results of a recent study published in PLoS One.

In this prospective observational study, 95 patients admitted to the emergency department (ED) with sepsis and hyperlactatemia who underwent initial fluid resuscitation were included in the study. Following initial fluid resuscitation, CRT was categorized as normal or abnormal, and mortality rates and clinical outcomes were compared between groups.

Abnormal CRT was reported for 29 patients at ED arrival and for 8 patients after initial fluid resuscitation.

The risk of adverse outcomes was increased among patients with abnormal CRT following fluid resuscitation (88%) compared with patients with normal CRT (20%; relative risk [RR] 4.4; P <.001). Similarly, hospital mortality rates were higher among patients with abnormal CRT (63%) vs patients with normal CRT (9%; RR 6.7; P <.001).

A higher proportion of patients with normal CRT after fluid resuscitation demonstrated normalized or decreased lactate levels compared with patients with abnormal CRT (77% vs 38%; P =.01).

CRT status at ED arrival did not predict clinical outcomes.

The study authors concluded that “patients with sepsis and hyperlactatemia exhibiting normal CRT after the very first fluid resuscitation in the ED have a low morbidity and mortality risk. In contrast, abnormal peripheral perfusion despite initial [fluid resuscitation] is a strong predictor of worse outcome.”

Reference

Lara B, Enberg L, Ortega M, et al. Capillary refill time during fluid resuscitation in patients with sepsis-related hyperlactatemia at the emergency department is related to mortalityPLoS One. 2017;12(11):e0188548.

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