Prognostic Value of the Indocyanine Green Plasma Disappearance Rate in Critically Ill Patients

Objective Measurement of the indocyanine green plasma disappearance rate (ICG-PDR) has been proposed as a clinical tool for the assessment of liver perfusion and function in transplant donors as well as a prognostic marker. In this study, we analyzed the prognostic value of the ICG-PDR in critically ill patients. Design Retrospective analysis. Setting Operative ICU of a university hospital. Measurements and results We analyzed 336 critically ill patients (120 female and 216 male; age range, 10 to 89 years; mean ŷ SD age, 53 ŷ 19 years) who were treated in our ICU between 1996 and 2000. All these patients were hemodynamically monitored by the transpulmonary double indicator (thermo-dye) dilution technique. Each patient received a femoral artery sheath through which a 4F flexible catheter with an integrated thermistor and fiberoptic was advanced into the abdominal aorta. The ICG-PDR was calculated using a computer system. For each measurement, 15 to 17 mL of 2% indocyanine green were injected in a central vein. Statistical analysis using the lowest value of the ICG-PDR in each individual showed that it was significantly lower in nonsurvivors (n = 168) than in survivors (n = 168) [median, 6.4%/min vs 16.5%/min; p Conclusion The ICG-PDR as a marker of liver perfusion and function is a good predictor of survival in critically ill patients: mortality increased with lower ICG-PDR values, and nonsurvivors had significantly lower ICG-PDR values than survivors. Sensitivity and specificity of the ICG-PDR on ICU admission with respect to survival was comparable to that of APACHE II and SAPS II scores.