TY - JOUR

T1 - Peripheral perfusion index stratifies risk in patients with intraoperative anemia

T2 - A multicentre cohort study

AU - Lau, Frederik F.

AU - Agerskov, Marianne

AU - Thusholdt, Anna N.W.

AU - Højlund, Jakob

AU - Meyhoff, Christian S.

AU - Jans, Øivind

AU - Foss, Nicolai B.

N1 - Publisher Copyright: © 2023

PY - 2024

Y1 - 2024

N2 - Study objective: Evidence for red blood cell (RBC) transfusion thresholds in the intraoperative setting is limited, and current perioperative recommendations may not correspond with individual intraoperative physiological demands. Hemodynamics relevant for the decision to transfuse may include peripheral perfusion index (PPI). The objective of this prospective study was to assess the associations of PPI and hemoglobin levels with the risk of postoperative morbidity and mortality. Design: Multicenter cohort study. Setting: Bispebjerg and Hvidovre University Hospitals, Copenhagen, Denmark. Patients: We included 741 patients who underwent acute high risk abdominal surgery or hip fracture surgery. Interventions: No interventions were carried out. Measurements: Principal values collected included measurements of peripheral perfusion index and hemoglobin values. Methods: The study was conducted using prospectively obtained data on adults who underwent emergency high-risk surgery. Subjects were categorized into high vs. low subgroups stratified by pre-defined PPI levels (PPI: > 1.5 vs. < 1.5) and Hb levels (Hb: > 9.7 g/dL vs. < 9.7 g/dL). The study assessed mortality and severe postoperative complications within 90 days. Main results: We included 741 patients. 90-day mortality was 21% (n = 154), frequency of severe postoperative complications was 31% (n = 231). Patients with both low PPI and low Hb had the highest adjusted odds ratio for both 90-day severe postoperative complications (2.95, [1.62–5.45]) and 90-day mortality (3.13, [1.45–7.11]). A comparison of patients with low PPI and low Hb to those with high PPI and low Hb detected significantly higher 90-day mortality risk in the low PPI and low Hb group (OR 8.6, [1.57–162.10]). Conclusion: High PPI in acute surgical patients who also presents with anemia was associated with a significantly better outcome when compared with patients with both low PPI and anemia. PPI should therefore be further investigated as a potential parameter to guide intraoperative RBC transfusion therapy.

AB - Study objective: Evidence for red blood cell (RBC) transfusion thresholds in the intraoperative setting is limited, and current perioperative recommendations may not correspond with individual intraoperative physiological demands. Hemodynamics relevant for the decision to transfuse may include peripheral perfusion index (PPI). The objective of this prospective study was to assess the associations of PPI and hemoglobin levels with the risk of postoperative morbidity and mortality. Design: Multicenter cohort study. Setting: Bispebjerg and Hvidovre University Hospitals, Copenhagen, Denmark. Patients: We included 741 patients who underwent acute high risk abdominal surgery or hip fracture surgery. Interventions: No interventions were carried out. Measurements: Principal values collected included measurements of peripheral perfusion index and hemoglobin values. Methods: The study was conducted using prospectively obtained data on adults who underwent emergency high-risk surgery. Subjects were categorized into high vs. low subgroups stratified by pre-defined PPI levels (PPI: > 1.5 vs. < 1.5) and Hb levels (Hb: > 9.7 g/dL vs. < 9.7 g/dL). The study assessed mortality and severe postoperative complications within 90 days. Main results: We included 741 patients. 90-day mortality was 21% (n = 154), frequency of severe postoperative complications was 31% (n = 231). Patients with both low PPI and low Hb had the highest adjusted odds ratio for both 90-day severe postoperative complications (2.95, [1.62–5.45]) and 90-day mortality (3.13, [1.45–7.11]). A comparison of patients with low PPI and low Hb to those with high PPI and low Hb detected significantly higher 90-day mortality risk in the low PPI and low Hb group (OR 8.6, [1.57–162.10]). Conclusion: High PPI in acute surgical patients who also presents with anemia was associated with a significantly better outcome when compared with patients with both low PPI and anemia. PPI should therefore be further investigated as a potential parameter to guide intraoperative RBC transfusion therapy.

KW - Hemoglobin transfusion thresholds

KW - Intraoperative anemia

KW - Intraoperative red blood cell transfusion

KW - Perfusion index (PI)

KW - Peripheral perfusion index (PPI)

KW - Red blood cell transfusion

U2 - 10.1016/j.jclinane.2024.111472

DO - 10.1016/j.jclinane.2024.111472

M3 - Journal article

C2 - 38613938

AN - SCOPUS:85189901949

VL - 95

JO - Journal of Clinical Anesthesia

JF - Journal of Clinical Anesthesia

SN - 0952-8180

M1 - 111472

ER -