Prognostic value of indocyanine green-plasma disappearance rate in critically ill patients

Background

Monitoring of regional organ blood flow and function is often crucial for guiding therapy in critically ill patients. In particular, indocyanine green-plasma disappearance rate (ICG-PDR) has been proposed for the assessment of liver function and its value has been demonstrated in evaluation of donor organs [1] and as prognostic marker in 39 critically ill patients [2].

Methods

We retrospectively analyzed 336 critically ill patients (120 female, 216 male, age 10–89 years, mean 53 ± 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. Statistical analysis for ICG-PDR in survivors (n = 168) and non-survivors (n = 168) was based on the lowest value of ICG-PDR in each individual.

Results

ICG-PDR was significantly lower in non-survivors than in survivors (median 6.4 vs 16.5 [%/min]) (P < 0.001). Mortality was about 80% in patients with ICG-PDR below 8 (%/min) and survival about 80% in those with ICG-PDR above 16 (%/min). Within three different sub-groups of patients (sepsis, ARDS, and others) survivors had significantly higher ICG-PDR than non-survivors (Fig.).

Figure

Conclusion

ICG-PDR correlates well with survival of critically ill patients. For the future, measurement of ICG-PDR seems to be a promising clinical tool, particularly since accurate and non-invasive transcutaneous assessment at the bedside has become possible.