Prognostic value of indocyanine green elimination assessed with LiMON in septic patients

Abstract 

Background

Sepsis is the most frequent infection with high mortality rates in intensive care units (ICUs), and the prediction of outcome is important in the decision-making process.

Objective

To assess the value of the Acute Physiology and Chronic Health Evaluation II (APACHE II) and indocyanin green (ICG) plasma disappearance rate (ICG-PDR) in septic patients.

Design

Retrospective analysis.

Measurements and Results

We analyzed 40 septic patients (17 female and 23 male; age range, 20-89 years) who were treated in our ICU. The ICG-PDR measurement and APACHE II score measurement were made within 24 hours after admission to the ICU. Indocyanine green elimination tests were conducted concurrently using the noninvasive liver function monitoring system (LiMON, Pulsion Medical Systems, Munich, Germany). A dose of 0.3 mg/kg ICG was given through a cubital fossa vein as a bolus.

Results

Statistical analysis showed that ICG-PDR was significantly lower in nonsurvivors (n = 18) than in survivors (n = 22) (mean, 12.1% ± 7.6%/min; median, 9%/min, vs mean, 21.2% ± 10.1%/min; median, 20%/min, respectively [P = .004]). The area under the curve as a measure of accuracy was 0.765 for ICG-PDR and 0.692 for APACHE II. Mortality was 80% in patients with ICG-PDR below 8% per minute, and survival was approximately 89% in patients with ICG-PDR above 24% per minute.

Conclusion

The results suggest that ICG-PDR, assessed with a user-friendly noninvasive bedside LiMON device, is a good predictor of survival in septic patients. Sensitivity and specificity of the noninvasive measurement of ICG-PDR on ICU admission was comparable to that obtained by APACHE II scores.

Keywords: Indocyanine green, Plasma disappearance rate, Acute physiology and chronic health evaluation, Prognostic factor, Sepsis