Severe abnormalities in microvascular perfused vessel density are associated to organ dysfunctions and mortality and can be predicted by hyperlactatemia and norepinephrine requirements in septic shock patients Glenn Hernandez MD a,b, ⁎ , E. Christiaan Boerma MD, PhD c , Arnaldo Dubin MD, PhD d , Alejandro Bruhn MD, PhD b , Matty Koopmans RN c , Vanina Kanoore Edul MD d , Carolina Ruiz MD b , Ricardo Castro MD b , Mario Omar Pozo MD d , Cesar Pedreros MD b , Enrique Veas MD b , Andrea Fuentealba MD b , Eduardo Kattan MD b , Maximiliano Rovegno MD b , Can Ince PhD b a Department of Translational Physiology, Academic Medical Center, University of Amsterdam, Meibergdreef 9, 1105 AZ Amsterdam, The Netherlands b Departamento de Medicina Intensiva, Pontificia Universidad Catolica de Chile, Marcoleta 367 Santiago Chile 8320000 c Departament of Intensive Care, Medical Center Leeuwarden, 8901 BR Leeuwarden, The Netherlands d Servicio de Terapia Intensiva, Sanatorio Otamendi y Miroli, Buenos Aires C1115AAB, Argentina Keywords: Septic shock; Lactate; Microcirculation; Norepinephrine; Mixed venous oxygen saturation; Perfusion Abstract Purpose: The aims of this study are to determine the general relationship of perfused vessel density (PVD) to mortality and organ dysfunctions and to explore if patients in the lowest quartile of distribution for this parameter present a higher risk of bad outcome and to identify systemic hemodynamic and perfusion variables that enhances the probability of finding a severe underlying microvascular dysfunction. Materials and Methods: This is a retrospective multicenter study including 122 septic shock patients participating in 7 prospective clinical trials on which at least 1 sublingual microcirculatory assessment was performed during early resuscitation. Results: Perfused vessel density was significantly related to organ dysfunctions and mortality, but this effect was largely explained by patients in the lowest quartile of distribution for PVD (P = .037 [odds ratio {OR}, 8.7; 95% confidence interval {CI}, 1.14-66.78] for mortality). Hyperlactatemia ( P b .026 [OR, 1.23; 95% CI, 1.03- 1.47]) and high norepinephrine requirements ( P b .019 [OR, 7.04; 95% CI, 1.38-35.89]) increased the odds of finding a severe microvascular dysfunction. Conclusions: Perfused vessel density is significantly related to organ dysfunctions and mortality in septic shock patients, particularly in patients exhibiting more severe abnormalities as represented by the lowest quartile of distribution for this parameter. The presence of hyperlactatemia and high norepinephrine requirements increases ⁎ Corresponding author. Departamento de Medicina Intensiva, Pontificia Universidad Catolica de Chile, Marcoleta 367 Santiago Chile 8320000. Tel.: + 56 23543972. E-mail address: glennguru@gmail.com (G. Hernandez). 0883-9441/$ – see front matter © 2013 Elsevier Inc. All rights reserved. http://dx.doi.org/10.1016/j.jcrc.2012.11.022 Journal of Critical Care (2013) 28, 538.e9–538.e14