The Accuracy of the Passive Leg Raising Test Using the Perfusion Index to Identify Preload Responsiveness—A Single Center Study in a Resource-Limited Setting
Issued Date
2025-01-01
Resource Type
eISSN
20754418
Scopus ID
2-s2.0-85214514297
Journal Title
Diagnostics
Volume
15
Issue
1
Rights Holder(s)
SCOPUS
Bibliographic Citation
Diagnostics Vol.15 No.1 (2025)
Suggested Citation
Casazzo M., Pisani L., Md Erfan Uddin R.A., Sattar A., Mirzada R., Zahed A.S.M., Sarkar S., Barua A., Paul S., Faiz M.A., Sayeed A.A., Leopold S.J., Lee S.J., Mukaka M., Hassan Chowdhury M.A., Srinamon K., Schilstra M., Dutta A.K., Grasso S., Schultz M.J., Ghose A., Dondorp A., Plewes K. The Accuracy of the Passive Leg Raising Test Using the Perfusion Index to Identify Preload Responsiveness—A Single Center Study in a Resource-Limited Setting. Diagnostics Vol.15 No.1 (2025). doi:10.3390/diagnostics15010103 Retrieved from: https://repository.li.mahidol.ac.th/handle/20.500.14594/102810
Title
The Accuracy of the Passive Leg Raising Test Using the Perfusion Index to Identify Preload Responsiveness—A Single Center Study in a Resource-Limited Setting
Author's Affiliation
Mahidol Oxford Tropical Medicine Research Unit
Università degli studi di Bari Aldo Moro
Monash University
Medizinische Universität Wien
Chittagong Medical College Hospital
The University of British Columbia
Nuffield Department of Medicine
Amsterdam UMC - University of Amsterdam
Bangladesh Institute of Tropical and Infectious Diseases
Malaria Research Group and Dev Care Foundation
Università degli studi di Bari Aldo Moro
Monash University
Medizinische Universität Wien
Chittagong Medical College Hospital
The University of British Columbia
Nuffield Department of Medicine
Amsterdam UMC - University of Amsterdam
Bangladesh Institute of Tropical and Infectious Diseases
Malaria Research Group and Dev Care Foundation
Corresponding Author(s)
Other Contributor(s)
Abstract
Background: We investigated the accuracy of predicting preload responsiveness by means of a passive leg raising test (PLR) using the perfusion index (PI) in critically ill patients showing signs of hypoperfusion in a resource-limited setting. Methods: We carried out a prospective observational single center study in patients admitted for sepsis or severe malaria with signs of hypoperfusion in Chattogram, Bangladesh. A PLR was performed at baseline, and at 6, 24, 48, and 72 h. Preload responsiveness assessed through PI was compared to preload responsiveness assessed through cardiac index (CI change ≥5%), as reference test. The primary endpoint was the accuracy of preload responsiveness prediction of PLR using PI at baseline; secondary endpoints were the accuracies at 6, 24, 48, and 72 h. Receiver operating characteristic (ROC) curves were constructed. Results: The study included 34 patients admitted for sepsis with signs of hypoperfusion and 10 patients admitted for severe malaria. Of 168 PLR tests performed, 143 had reliable PI measurements (85%). The best identified PI change cutoff to discriminate responders from non–responders was 9.7%. The accuracy of PLR using PI in discriminating a preload responsive patient at baseline was good (area under the ROC 0.87 95% CI 0.75–0.99). The test showed high sensitivity and negative predictive value, with comparably lower specificity and positive predictive value. Compared to baseline, the AUROC of PLR using PI was lower at 6, 24, 48, and 72 h. Restricting the analysis to sepsis patients did not change the findings. Conclusions: In patients with sepsis or severe malaria and signs of hypoperfusion, changes in PI after a PLR test detected preload responsiveness. The diagnostic accuracy was better when PI changes were measured at baseline.