Critical Care volume 29,
Article number: 57 (2025)
Published: 04 February 2025
Background
Capillary refill
time (CRT) and skin blood flow (SBF) have been reported to be strong predictors
of mortality in critically ill patients. However, the relationship between both
parameters remains unclear.
Methods
We conducted a
prospective observational study in a tertiary teaching hospital. All patients
older than 18 years admitted in the intensive care unit (ICU) with
circulatory failure and a measurable CRT were included. We assessed index SBF
by laser doppler flowmetry and CRT on the fingertip, at T0 (Within the first
48 h from admission) and T1 (4 to 6 h later). Correlation was
computed using Spearman or Pearson’s formula.
Results
During a 2-month
period, 50 patients were included, 54% were admitted for sepsis. At
baseline median CRT was 2.0 [1.1–3.9] seconds and median SBF was 46 [20–184]
PU. At baseline SBF strongly correlated with CRT (R2 = 0.89; p < 0.0001, curvilinear relationship), this
correlation was maintained whether patients were septic or not (R2 = 0.94; p = 0.0013; R2 = 0.87; p < 0.0001, respectively), and whether they
received norepinephrine or not (R2 = 0.97; p = 0.0035;
R2 = 0.92; p < 0.0001, respectively). Between T0 and T1,
changes in SBF also significantly correlated with changes in CRT (R2 = 0.34; p < 0.0001). SBF was related to tissue perfusion
parameters such as arterial lactate level (p = 0.02), whilst no
correlation was found with cardiac output. In addition, only survivors
significantly improved their SBF between T0 and T1. SBF was a powerful
predictor of day-28 mortality as the AUROC at T0 was 85% [95% IC [76–91]] and at T1 90% [95% IC [78–100]].
Conclusion
We have shown that
index CRT and SBF were correlated, providing evidence that CRT is a reliable
marker of microvascular blood flow.
Trial registration Comité
de protection des personnes Ouest II N° 2023-A02046-39.
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