Evaluation of the correlation between perfusion index and prognosis in patients with chronic obstructive pulmonary disease

Abstract

Objectives: This study aims to investigate whether perfusion index (PI) values, which are measured non-invasively, affect emergency management, especially in hospitalization and discharge decision in patients with Chronic Obstructive Pulmonary Disease (COPD).

Methods: Patients who were admitted to the emergency department of Okmeydanı Training and Research Hospital with a COPD exacerbation in 3-months period and who volunteered to participate were included in the study. Vital parameters and PI values of the patients at the time of admission, at the first, second and third hour of the admittance and at the time of hospitalization (in the case of hospitalization) were recorded. The patients were treated for COPD exacerbation according to the Global Initiative for Chronic Obstructive Lung Disease 2011 guide and the decision of discharge, hospitalization in the emergency department, andhospitalization in the intensive care unit was taken based on the relevant guideline.

Results: A total of 57 patients were included in the study. Of the patients, 45 (78.9%) were male. The mean age of the patients was 65.65 ± 9.90 years. There was no statistically significant difference in arrival vital parameters and PI in terms of the gender (p > 0.05). The change between PI values at the time of admission and the first hour in the patients admitted to intensive care unit was found to be significantly lower compared to patients who were hospitalized in the emergency department or discharged (p = 0.035; p = 0.033). The difference between the PI values at the time of admission and at the third hour of the follow up of the discharged patients was found to be significantly higher compared to the hospitalized patients (p = 0.035). There was no statistically significant difference between the arrival PI measurements in terms of the presence of comorbid diseases (p > 0.05).

Conclusions: Considering the hourly changes, the PI values of patients admitted to the emergency department with COPD exacerbation may be helpful in predicting the decision of discharge, hospitalization in the emergency department or intensive care unit.

Keywords

• Emergency department;
• Chronic obstructive pulmonary disease;
• Perfusion index;

References

1. 1. Jiang Y, Liu F, Guo J, Sun P, Chen Z, Li J, et al. Evaluating an intervention program using WeChat for patients with chronic obstructive pulmonary disease: randomized controlled trial. J Med Internet Res 2020;22:e17089.
2. 2. Li XJ, Kang Y, Wang RR, Liao XL, Ou XF, Liu J, et al. The effects of safflower yellow on acute exacerbation of chronic obstructive pulmonary disease: a randomized, controlled clinical trial. Evid Based Complement Alternat Med 2019;2019:5952742.
3. 3. GBD 2016 Causes of Death Collaborators. Global, regional, and national age-sex specific mortality for 264 causes of death, 1980-2016: a systematic analysis for the Global Burden of Disease Study 2016. Lancet 2017;390:1151-210.
4. 4. Cai L, Wang XM, Fan LM, Shen JR, Liu YN, Golden AR. Socioeconomic variations in chronic obstructive pulmonary disease prevalence, diagnosis, and treatment in rural Southwest China. BMC Public Health 2020;20:536.
5. 5. Gottrup F. Physiology and measurement of tissue perfusion. Ann Chir Gynaecol 1994;83:183-9.
6. 6. Rady MY, Rivers EP, Nowak RM. Resuscitation of the critically III in the ED: responses of blood pressure, heart rate, shock index, central venous oxygen saturation, and lactate. Am J Emerg Med 1996;14:218-25.
7. 7. Lima A, Jansen TC, van Bommel J, Ince C, Bakker J. The prognostic value of the subjective assessment of peripheral perfusion in critically ill patients. Crit Care Med 2009;37:934-8.
8. 8. Shoemaker WC, Wo CC, Chan L, Ramicone E, Kamel ES, Velmahos GC, et al. Outcome prediction of emergency patients by noninvasive hemodynamic monitoring. Chest 2001;120:528-37.

9. 9. Hong Y, Graham MM, Southern D, McMurtry MS. The association between chronic obstructive pulmonary disease and coronary artery disease in patients undergoing coronary angiography. COPD 2019;16:66-71.
10. 10. Nunez A, Marras V, Harlander M, Mekov E, Esquinas C, Turel M, et al. Association between routine blood biomarkers and clinical phenotypes and exacerbations in chronic obstructive pulmonary disease. Int J Chron Obstruct Pulmon Dis 2020;15:681-90.
11. 11. Kar S, Zengin N. [Examining the state of health in patients with COPD according to sociodemographic and disease-related characteristics]. . J Pro Health Res 2019;1:1-7. [Article in Turkish]
12. 12. Dalal AA, Christensen L, Liu F, Riedel AA. Direct costs of chronic obstructive pulmonary disease among managed care patients. Int J Chron Obstruct Pulmon Dis 2010;5:341-9.
13. 13. Sin DD, Anthonisen NR, Soriano JB, Agusti AG. Mortality in COPD: role of comorbidities. Eur Respir J 2006;28:1245-57.
14. 14. Mannino DM, Thorn D, Swensen A, Holguin F. Prevalence and outcomes of diabetes, hypertension and cardiovascular disease in COPD. Eur Respir J 2008;32:962-9.
15. 15. Rutten FH, Cramer MJ, Lammers JW, Grobbee DE, Hoes AW. Heart failure and chronic obstructive pulmonary disease: An ignored combination? Eur J Heart Fail 2006;8:706-11.
16. 16. Mannino DM, Aguayo SM, Petty TL, Redd SC. Low lung function and incident lung cancer in the United States: data From the First National Health and Nutrition Examination Survey follow-up. Arch Intern Med 2003;163:1475-80.
17. 17. Kuyucu T, Guclu SZ, Saylan B, Demir C, Senol T, Guner S, et al. A cross-sectional observational study to investigate daily symptom variability, effects of symptom on morning activities and therapeutic expectations of patients and physicians in COPD-SUNRISE study. Tuberk Toraks 2011;59:328-39.
18. 18. Keegan MT, Gajic O, Afessa B. Severity of illness scoring systems in the intensive care unit. Crit Care Med 2011;39:163-9.
19. 19. Lima AP, Beelen P, Bakker J. Use of a peripheral perfusion index derived from the pulse oximetry signal as a noninvasive indicator of perfusion. Crit Care Med 2002;30:1210-3.
20. 20. Lima A, van Bommel J, Sikorska K, van Genderen M, Klijn E, Lesaffre E, et al. The relation of near-infrared spectroscopy with changes in peripheral circulation in critically ill patients. Crit Care Med 2011;39:1649-54.
21. 21. Acar Y. The effectiveness of peripheral perfusion index in predicting mortality and perfusion status of patients [Thesis]. GATA; 2012.
22. 22. Hummler HD, Engelmann A, Pohlandt F, Högel J, Franz AR. Decreased accuracy of pulse oximetry measurements during low perfusion caused by sepsis: Is the perfusion index of any value? Intens Care Med 2006;32:1428-31.