Skip to main content

Observational study of the effects of age, diabetes mellitus, cirrhosis and chronic kidney disease on sublingual microvascular flow


Sidestream dark-field (SDF) imaging is an important new technology that has been used to demonstrate microcirculatory abnormalities in a variety of critical illnesses [1]. The microcirculation is also affected by age and chronic comorbidities. However, the effect of these conditions on SDF microcirculatory parameters has not been well described.


Sublingual SDF images were obtained from five groups of 20 participants: healthy volunteers under 25 years, healthy volunteers over 55 years, and stable patients over 55 years with one of diabetes mellitus (DM), cirrhosis and stage 5 chronic kidney disease (CKD). Microcirculatory parameters [1] between the groups were then compared for significance using ANOVA for parametric data and the Kruskal-Wallis test for nonparametric data. This was approved by the local ethics committee.


All DM patients were type 2, with mean glycated haemoglobin (HbA1c) of 8.8% (SD 1.7%). Seventeen cirrhotic patients were Child- Pugh-Turcotte score A and one was score B. For CKD, the mean estimated glomerular filtration rate was 11.5 ml/minute (SD 2.9). Median microvascular flow index (MFI) was 2.85 (IQR 2.75 to 3.0) for participants aged <25, 2.81 (2.66 to 2.97) for those aged >55, 2.88 (2.75 to 3.0) for those with DM, 3.0 (2.83 to 3.0) for those with cirrhosis and 3.0 (2.78 to 3.0) for those with CKD (P for difference = 0.14). There were no significant differences in the proportion of perfused vessels and perfused vessel density between the groups. See Figure 1

Figure 1
figure 1



Older age, diabetes, and chronic kidney and liver disease need not be considered confounding factors for comparison of SDF microcirculatory parameters in the critically ill.


  1. De Backer D, et al.: How to evaluate the microcirculation: report of a round table conference. Crit Care 2007, 11: R101. 10.1186/cc6118

    Article  PubMed Central  PubMed  Google Scholar 

Download references

Author information

Authors and Affiliations


Rights and permissions

This article is licensed under a Creative Commons Attribution 4.0 International License, which permits use, sharing, adaptation, distribution and reproduction in any medium or format, as long as you give appropriate credit to the original author(s) and the source, provide a link to the Creative Commons licence, and indicate if changes were made. The images or other third party material in this article are included in the article's Creative Commons licence, unless indicated otherwise in a credit line to the material. If material is not included in the article's Creative Commons licence and your intended use is not permitted by statutory regulation or exceeds the permitted use, you will need to obtain permission directly from the copyright holder. To view a copy of this licence, visit The Creative Commons Public Domain Dedication waiver ( applies to the data made available in this article, unless otherwise stated in a credit line to the data.

Reprints and Permissions

About this article

Cite this article

Reynolds, T., Jhanji, S., Vivian-Smith, A. et al. Observational study of the effects of age, diabetes mellitus, cirrhosis and chronic kidney disease on sublingual microvascular flow. Crit Care 17 (Suppl 2), P215 (2013).

Download citation

  • Published:

  • DOI:


  • Diabetes Mellitus
  • Chronic Kidney Disease
  • Glomerular Filtration Rate
  • Glomerular Filtration
  • Cirrhotic Patient