Evaluation of intravenous fluid therapy in patients with sepsis registering to emergency department with pleth variability index and lactate measurements

Entrance Patients who applied to the emergency department and were diagnosed with sepsis as a result of the initial evaluation were included in this study. The lactate values obtained at the time of admission and at the first hour of follow-up, the measured pleth variability index (PVI) values, and the PVI-lactate indices obtained by using PVI and lactate together were recorded. With the changes in these values, it was aimed to determine the effectiveness of the fluid therapy given to the patients within the first hour. Materials and Methods Patients who were admitted to the emergency department and diagnosed with sepsis between April 2022 and December 2022 were prospectively included in this study. Demographic characteristics of the patients, lactate values, measured pleth variability index values, amount of fluid therapy given, emergency department outcomes, hospital outcomes and mortality were evaluated. Results 126 patients with a prediagnosis of sepsis were included in our study. 65.7% (n=67) of the patients were male and the mean age was 70.38 ± 14.11 years. The most common comorbid diseases were malignancy with 43.1% (n=44), diabetes mellitus with 26.5% (n=27), and hypertension with 25.5% (n=26). The death rate was found to be higher in patients with a fluid therapy amount of <11.75 liters compared to patients with fluid therapy ≥11.75 liters (p=0.013). For PVI value at admission, values higher than 21.50 resulted in a sensitivity of 77.42% and a sensitivity of 72%. It was determined that it could predict with a specificity of .73. It was determined that values of 2.00 and higher for lactate value at admission could predict mortality with 78.18% sensitivity and 74.55% specificity. It was determined that values of 0.41 and higher for the PVI-lactate index at admission could predict mortality with a sensitivity of 78.18% and a specificity of 68.63%. It was determined that values of 0.44 and higher for the PVI-lactate index measured at 1 hour could predict mortality with a sensitivity of 66.67% and a specificity of 68.18%. Conclusion High lactate and pleth variability index and pleth variability index-lactate indices are associated with mortality in patients diagnosed with sepsis. Although there were changes in the pleth variability index, lactate and pleth variability index-lactate indices after fluid therapy, there was no correlation with the amount of fluid therapy. Key words: Sepsis, PVI, lactate, mortality, emergency room