Evaluation of Sepsis using Compensatory Reserve Measurement: A Prospective Clinical Trial

BACKGROUND: Sepsis, a leading cause of morbidity and mortality worldwide, characterized by metabolic and hemodynamic changes that can lead to multi-organ failure, and death. The evaluation of a patient's condition is routinely performed by several objective criteria. The compensatory reserve measurement (CRM) represents a new paradigm that measures the total of all physiological compensatory mechanisms, using noninvasive photoplethysmography to read changes in arterial waveforms. The present study aim was to evaluate the applicability and the predictive value of the CRM during sepsis. METHODS: Data was prospectively collected from patients hospitalized in department of Surgery due to different inflammatory illnesses. All subjects were evaluated with, hemodynamic, laboratory measurements and CRM throughout hospitalization. RESULTS: Of 100 subjects enrolled, 84 patients were not septic. The remaining 16 patients were in sepsis (SOFA score > 2), six of whom were in septic shock and four died. When Non-septic patients were compared to septic patients, statistical differences were found in CRP level (P<0.0005), SOFA score (p<0.0005) and CRM (p<0.0001). Other parameters did not show any difference between groups. The area under the ROC (AUROC) curve for CRM was 1, significantly higher than the AUROC for HR (0.78), systolic blood pressure (0.67), q-SOFA (0.81) and respiratory rate (0.56). CONCLUSIONS: Clinical criteria, imaging and laboratory features used to identify a septic patient, are sub-optimal. This demonstrates the need for a monitoring device capable of detecting rapidly, constantly and simply the sum condition of the ill patient. We have shown that CRM was able to distinguish between severe septic and non-septic patients early in the course of hospitalization and was significantly more sensitive than the conventional diagnostic tools. Such capability to assess the septic patients, or even to triage these patients will surely aid treatment of sepsis. LEVEL OF EVIDENCE: IICare Management.