The Accuracy of the Passive Leg Raising Test Using the Perfusion Index to Identify Preload Responsiveness—A Single Center Study in a Resource-Limited Setting
<b>Background:</b> We investigated the accuracy of predicting preload responsiveness by means of a passive leg raising test (PLR) using the perfusion index (PI) in critically ill patients showing signs of hypoperfusion in a resource-limited setting. <b>Methods:</b> We carried...
Saved in:
| Main Authors: | , , , , , , , , , , , , , , , , , , , , , , |
|---|---|
| Format: | Article |
| Language: | English |
| Published: |
MDPI AG
2025-01-01
|
| Series: | Diagnostics |
| Subjects: | |
| Online Access: | https://www.mdpi.com/2075-4418/15/1/103 |
| Tags: |
Add Tag
No Tags, Be the first to tag this record!
|
| _version_ | 1841549312794820608 |
|---|---|
| author | Marialessia Casazzo Luigi Pisani Rabiul Alam Md Erfan Uddin Abdus Sattar Rashed Mirzada Abu Shahed Mohammad Zahed Shoman Sarkar Anupam Barua Sujat Paul Mohammad Abul Faiz Abdullah Abu Sayeed Stije J. Leopold Sue J. Lee Mavuto Mukaka Mohammed Abul Hassan Chowdhury Ketsanee Srinamon Marja Schilstra Asok Kumar Dutta Salvatore Grasso Marcus J. Schultz Aniruddha Ghose Arjen Dondorp Katherine Plewes |
| author_facet | Marialessia Casazzo Luigi Pisani Rabiul Alam Md Erfan Uddin Abdus Sattar Rashed Mirzada Abu Shahed Mohammad Zahed Shoman Sarkar Anupam Barua Sujat Paul Mohammad Abul Faiz Abdullah Abu Sayeed Stije J. Leopold Sue J. Lee Mavuto Mukaka Mohammed Abul Hassan Chowdhury Ketsanee Srinamon Marja Schilstra Asok Kumar Dutta Salvatore Grasso Marcus J. Schultz Aniruddha Ghose Arjen Dondorp Katherine Plewes |
| author_sort | Marialessia Casazzo |
| collection | DOAJ |
| description | <b>Background:</b> We investigated the accuracy of predicting preload responsiveness by means of a passive leg raising test (PLR) using the perfusion index (PI) in critically ill patients showing signs of hypoperfusion in a resource-limited setting. <b>Methods:</b> We carried out a prospective observational single center study in patients admitted for sepsis or severe malaria with signs of hypoperfusion in Chattogram, Bangladesh. A PLR was performed at baseline, and at 6, 24, 48, and 72 h. Preload responsiveness assessed through PI was compared to preload responsiveness assessed through cardiac index (CI change ≥5%), as reference test. The primary endpoint was the accuracy of preload responsiveness prediction of PLR using PI at baseline; secondary endpoints were the accuracies at 6, 24, 48, and 72 h. Receiver operating characteristic (ROC) curves were constructed. <b>Results:</b> The study included 34 patients admitted for sepsis with signs of hypoperfusion and 10 patients admitted for severe malaria. Of 168 PLR tests performed, 143 had reliable PI measurements (85%). The best identified PI change cutoff to discriminate responders from non–responders was 9.7%. The accuracy of PLR using PI in discriminating a preload responsive patient at baseline was good (area under the ROC 0.87 95% CI 0.75–0.99). The test showed high sensitivity and negative predictive value, with comparably lower specificity and positive predictive value. Compared to baseline, the AUROC of PLR using PI was lower at 6, 24, 48, and 72 h. Restricting the analysis to sepsis patients did not change the findings. <b>Conclusions:</b> In patients with sepsis or severe malaria and signs of hypoperfusion, changes in PI after a PLR test detected preload responsiveness. The diagnostic accuracy was better when PI changes were measured at baseline. |
| format | Article |
| id | doaj-art-ee0a407d0f1a4b2fa6bf8700c34d296c |
| institution | Kabale University |
| issn | 2075-4418 |
| language | English |
| publishDate | 2025-01-01 |
| publisher | MDPI AG |
| record_format | Article |
| series | Diagnostics |
| spelling | doaj-art-ee0a407d0f1a4b2fa6bf8700c34d296c2025-01-10T13:16:44ZengMDPI AGDiagnostics2075-44182025-01-0115110310.3390/diagnostics15010103The Accuracy of the Passive Leg Raising Test Using the Perfusion Index to Identify Preload Responsiveness—A Single Center Study in a Resource-Limited SettingMarialessia Casazzo0Luigi Pisani1Rabiul Alam Md Erfan Uddin2Abdus Sattar3Rashed Mirzada4Abu Shahed Mohammad Zahed5Shoman Sarkar6Anupam Barua7Sujat Paul8Mohammad Abul Faiz9Abdullah Abu Sayeed10Stije J. Leopold11Sue J. Lee12Mavuto Mukaka13Mohammed Abul Hassan Chowdhury14Ketsanee Srinamon15Marja Schilstra16Asok Kumar Dutta17Salvatore Grasso18Marcus J. Schultz19Aniruddha Ghose20Arjen Dondorp21Katherine Plewes22Department of Anesthesia and Intensive Care, University of Bari, 70124 Bari, ItalyDepartment of Anesthesia and Intensive Care, University of Bari, 70124 Bari, ItalyDepartment of Medicine, Chittagong Medical College Hospital, Chattogram 4203, BangladeshDepartment of Medicine, Chittagong Medical College Hospital, Chattogram 4203, BangladeshDepartment of Medicine, Chittagong Medical College Hospital, Chattogram 4203, BangladeshDepartment of Medicine, Chittagong Medical College Hospital, Chattogram 4203, BangladeshDepartment of Medicine, Chittagong Medical College Hospital, Chattogram 4203, BangladeshDepartment of Medicine, Chittagong Medical College Hospital, Chattogram 4203, BangladeshDepartment of Medicine, Chittagong Medical College Hospital, Chattogram 4203, BangladeshMalaria Research Group & Dev Care Foundation, Dhaka 1209, BangladeshDepartment of Medicine, Chittagong Medical College Hospital, Chattogram 4203, BangladeshDepartment of Internal Medicine, Amsterdam University Medical Centers, Location AMC, 1105 AZ Amsterdam, The NetherlandsMahidol–Oxford Tropical Medicine Research Unit (MORU), Mahidol University, Bangkok 10400, ThailandMahidol–Oxford Tropical Medicine Research Unit (MORU), Mahidol University, Bangkok 10400, ThailandBangladesh Institute for Tropical Infectious Diseases, Chattogram 4217, BangladeshMahidol–Oxford Tropical Medicine Research Unit (MORU), Mahidol University, Bangkok 10400, ThailandMahidol–Oxford Tropical Medicine Research Unit (MORU), Mahidol University, Bangkok 10400, ThailandDepartment of Medicine, Chittagong Medical College Hospital, Chattogram 4203, BangladeshDepartment of Anesthesia and Intensive Care, University of Bari, 70124 Bari, ItalyMahidol–Oxford Tropical Medicine Research Unit (MORU), Mahidol University, Bangkok 10400, ThailandDepartment of Medicine, Chittagong Medical College Hospital, Chattogram 4203, BangladeshMahidol–Oxford Tropical Medicine Research Unit (MORU), Mahidol University, Bangkok 10400, ThailandMahidol–Oxford Tropical Medicine Research Unit (MORU), Mahidol University, Bangkok 10400, Thailand<b>Background:</b> We investigated the accuracy of predicting preload responsiveness by means of a passive leg raising test (PLR) using the perfusion index (PI) in critically ill patients showing signs of hypoperfusion in a resource-limited setting. <b>Methods:</b> We carried out a prospective observational single center study in patients admitted for sepsis or severe malaria with signs of hypoperfusion in Chattogram, Bangladesh. A PLR was performed at baseline, and at 6, 24, 48, and 72 h. Preload responsiveness assessed through PI was compared to preload responsiveness assessed through cardiac index (CI change ≥5%), as reference test. The primary endpoint was the accuracy of preload responsiveness prediction of PLR using PI at baseline; secondary endpoints were the accuracies at 6, 24, 48, and 72 h. Receiver operating characteristic (ROC) curves were constructed. <b>Results:</b> The study included 34 patients admitted for sepsis with signs of hypoperfusion and 10 patients admitted for severe malaria. Of 168 PLR tests performed, 143 had reliable PI measurements (85%). The best identified PI change cutoff to discriminate responders from non–responders was 9.7%. The accuracy of PLR using PI in discriminating a preload responsive patient at baseline was good (area under the ROC 0.87 95% CI 0.75–0.99). The test showed high sensitivity and negative predictive value, with comparably lower specificity and positive predictive value. Compared to baseline, the AUROC of PLR using PI was lower at 6, 24, 48, and 72 h. Restricting the analysis to sepsis patients did not change the findings. <b>Conclusions:</b> In patients with sepsis or severe malaria and signs of hypoperfusion, changes in PI after a PLR test detected preload responsiveness. The diagnostic accuracy was better when PI changes were measured at baseline.https://www.mdpi.com/2075-4418/15/1/103fluid responsivenesshypoperfusionsepsismalariapassive leg raisingPLR |
| spellingShingle | Marialessia Casazzo Luigi Pisani Rabiul Alam Md Erfan Uddin Abdus Sattar Rashed Mirzada Abu Shahed Mohammad Zahed Shoman Sarkar Anupam Barua Sujat Paul Mohammad Abul Faiz Abdullah Abu Sayeed Stije J. Leopold Sue J. Lee Mavuto Mukaka Mohammed Abul Hassan Chowdhury Ketsanee Srinamon Marja Schilstra Asok Kumar Dutta Salvatore Grasso Marcus J. Schultz Aniruddha Ghose Arjen Dondorp Katherine Plewes The Accuracy of the Passive Leg Raising Test Using the Perfusion Index to Identify Preload Responsiveness—A Single Center Study in a Resource-Limited Setting Diagnostics fluid responsiveness hypoperfusion sepsis malaria passive leg raising PLR |
| title | The Accuracy of the Passive Leg Raising Test Using the Perfusion Index to Identify Preload Responsiveness—A Single Center Study in a Resource-Limited Setting |
| title_full | The Accuracy of the Passive Leg Raising Test Using the Perfusion Index to Identify Preload Responsiveness—A Single Center Study in a Resource-Limited Setting |
| title_fullStr | The Accuracy of the Passive Leg Raising Test Using the Perfusion Index to Identify Preload Responsiveness—A Single Center Study in a Resource-Limited Setting |
| title_full_unstemmed | The Accuracy of the Passive Leg Raising Test Using the Perfusion Index to Identify Preload Responsiveness—A Single Center Study in a Resource-Limited Setting |
| title_short | The Accuracy of the Passive Leg Raising Test Using the Perfusion Index to Identify Preload Responsiveness—A Single Center Study in a Resource-Limited Setting |
| title_sort | accuracy of the passive leg raising test using the perfusion index to identify preload responsiveness a single center study in a resource limited setting |
| topic | fluid responsiveness hypoperfusion sepsis malaria passive leg raising PLR |
| url | https://www.mdpi.com/2075-4418/15/1/103 |
| work_keys_str_mv | AT marialessiacasazzo theaccuracyofthepassivelegraisingtestusingtheperfusionindextoidentifypreloadresponsivenessasinglecenterstudyinaresourcelimitedsetting AT luigipisani theaccuracyofthepassivelegraisingtestusingtheperfusionindextoidentifypreloadresponsivenessasinglecenterstudyinaresourcelimitedsetting AT rabiulalammderfanuddin theaccuracyofthepassivelegraisingtestusingtheperfusionindextoidentifypreloadresponsivenessasinglecenterstudyinaresourcelimitedsetting AT abdussattar theaccuracyofthepassivelegraisingtestusingtheperfusionindextoidentifypreloadresponsivenessasinglecenterstudyinaresourcelimitedsetting AT rashedmirzada theaccuracyofthepassivelegraisingtestusingtheperfusionindextoidentifypreloadresponsivenessasinglecenterstudyinaresourcelimitedsetting AT abushahedmohammadzahed theaccuracyofthepassivelegraisingtestusingtheperfusionindextoidentifypreloadresponsivenessasinglecenterstudyinaresourcelimitedsetting AT shomansarkar theaccuracyofthepassivelegraisingtestusingtheperfusionindextoidentifypreloadresponsivenessasinglecenterstudyinaresourcelimitedsetting AT anupambarua theaccuracyofthepassivelegraisingtestusingtheperfusionindextoidentifypreloadresponsivenessasinglecenterstudyinaresourcelimitedsetting AT sujatpaul theaccuracyofthepassivelegraisingtestusingtheperfusionindextoidentifypreloadresponsivenessasinglecenterstudyinaresourcelimitedsetting AT mohammadabulfaiz theaccuracyofthepassivelegraisingtestusingtheperfusionindextoidentifypreloadresponsivenessasinglecenterstudyinaresourcelimitedsetting AT abdullahabusayeed theaccuracyofthepassivelegraisingtestusingtheperfusionindextoidentifypreloadresponsivenessasinglecenterstudyinaresourcelimitedsetting AT stijejleopold theaccuracyofthepassivelegraisingtestusingtheperfusionindextoidentifypreloadresponsivenessasinglecenterstudyinaresourcelimitedsetting AT suejlee theaccuracyofthepassivelegraisingtestusingtheperfusionindextoidentifypreloadresponsivenessasinglecenterstudyinaresourcelimitedsetting AT mavutomukaka theaccuracyofthepassivelegraisingtestusingtheperfusionindextoidentifypreloadresponsivenessasinglecenterstudyinaresourcelimitedsetting AT mohammedabulhassanchowdhury theaccuracyofthepassivelegraisingtestusingtheperfusionindextoidentifypreloadresponsivenessasinglecenterstudyinaresourcelimitedsetting AT ketsaneesrinamon theaccuracyofthepassivelegraisingtestusingtheperfusionindextoidentifypreloadresponsivenessasinglecenterstudyinaresourcelimitedsetting AT marjaschilstra theaccuracyofthepassivelegraisingtestusingtheperfusionindextoidentifypreloadresponsivenessasinglecenterstudyinaresourcelimitedsetting AT asokkumardutta theaccuracyofthepassivelegraisingtestusingtheperfusionindextoidentifypreloadresponsivenessasinglecenterstudyinaresourcelimitedsetting AT salvatoregrasso theaccuracyofthepassivelegraisingtestusingtheperfusionindextoidentifypreloadresponsivenessasinglecenterstudyinaresourcelimitedsetting AT marcusjschultz theaccuracyofthepassivelegraisingtestusingtheperfusionindextoidentifypreloadresponsivenessasinglecenterstudyinaresourcelimitedsetting AT aniruddhaghose theaccuracyofthepassivelegraisingtestusingtheperfusionindextoidentifypreloadresponsivenessasinglecenterstudyinaresourcelimitedsetting AT arjendondorp theaccuracyofthepassivelegraisingtestusingtheperfusionindextoidentifypreloadresponsivenessasinglecenterstudyinaresourcelimitedsetting AT katherineplewes theaccuracyofthepassivelegraisingtestusingtheperfusionindextoidentifypreloadresponsivenessasinglecenterstudyinaresourcelimitedsetting AT marialessiacasazzo accuracyofthepassivelegraisingtestusingtheperfusionindextoidentifypreloadresponsivenessasinglecenterstudyinaresourcelimitedsetting AT luigipisani accuracyofthepassivelegraisingtestusingtheperfusionindextoidentifypreloadresponsivenessasinglecenterstudyinaresourcelimitedsetting AT rabiulalammderfanuddin accuracyofthepassivelegraisingtestusingtheperfusionindextoidentifypreloadresponsivenessasinglecenterstudyinaresourcelimitedsetting AT abdussattar accuracyofthepassivelegraisingtestusingtheperfusionindextoidentifypreloadresponsivenessasinglecenterstudyinaresourcelimitedsetting AT rashedmirzada accuracyofthepassivelegraisingtestusingtheperfusionindextoidentifypreloadresponsivenessasinglecenterstudyinaresourcelimitedsetting AT abushahedmohammadzahed accuracyofthepassivelegraisingtestusingtheperfusionindextoidentifypreloadresponsivenessasinglecenterstudyinaresourcelimitedsetting AT shomansarkar accuracyofthepassivelegraisingtestusingtheperfusionindextoidentifypreloadresponsivenessasinglecenterstudyinaresourcelimitedsetting AT anupambarua accuracyofthepassivelegraisingtestusingtheperfusionindextoidentifypreloadresponsivenessasinglecenterstudyinaresourcelimitedsetting AT sujatpaul accuracyofthepassivelegraisingtestusingtheperfusionindextoidentifypreloadresponsivenessasinglecenterstudyinaresourcelimitedsetting AT mohammadabulfaiz accuracyofthepassivelegraisingtestusingtheperfusionindextoidentifypreloadresponsivenessasinglecenterstudyinaresourcelimitedsetting AT abdullahabusayeed accuracyofthepassivelegraisingtestusingtheperfusionindextoidentifypreloadresponsivenessasinglecenterstudyinaresourcelimitedsetting AT stijejleopold accuracyofthepassivelegraisingtestusingtheperfusionindextoidentifypreloadresponsivenessasinglecenterstudyinaresourcelimitedsetting AT suejlee accuracyofthepassivelegraisingtestusingtheperfusionindextoidentifypreloadresponsivenessasinglecenterstudyinaresourcelimitedsetting AT mavutomukaka accuracyofthepassivelegraisingtestusingtheperfusionindextoidentifypreloadresponsivenessasinglecenterstudyinaresourcelimitedsetting AT mohammedabulhassanchowdhury accuracyofthepassivelegraisingtestusingtheperfusionindextoidentifypreloadresponsivenessasinglecenterstudyinaresourcelimitedsetting AT ketsaneesrinamon accuracyofthepassivelegraisingtestusingtheperfusionindextoidentifypreloadresponsivenessasinglecenterstudyinaresourcelimitedsetting AT marjaschilstra accuracyofthepassivelegraisingtestusingtheperfusionindextoidentifypreloadresponsivenessasinglecenterstudyinaresourcelimitedsetting AT asokkumardutta accuracyofthepassivelegraisingtestusingtheperfusionindextoidentifypreloadresponsivenessasinglecenterstudyinaresourcelimitedsetting AT salvatoregrasso accuracyofthepassivelegraisingtestusingtheperfusionindextoidentifypreloadresponsivenessasinglecenterstudyinaresourcelimitedsetting AT marcusjschultz accuracyofthepassivelegraisingtestusingtheperfusionindextoidentifypreloadresponsivenessasinglecenterstudyinaresourcelimitedsetting AT aniruddhaghose accuracyofthepassivelegraisingtestusingtheperfusionindextoidentifypreloadresponsivenessasinglecenterstudyinaresourcelimitedsetting AT arjendondorp accuracyofthepassivelegraisingtestusingtheperfusionindextoidentifypreloadresponsivenessasinglecenterstudyinaresourcelimitedsetting AT katherineplewes accuracyofthepassivelegraisingtestusingtheperfusionindextoidentifypreloadresponsivenessasinglecenterstudyinaresourcelimitedsetting |