Decreased peripheral perfusion measured by perfusion index is a novel indicator for cardiovascular death in patients with type 2 diabetes and established cardiovascular disease

Hiroshi Okada,Takashi Nishi,Tetsuro Yamane,Muhei Tanaka,Michiaki Fukui,Yuki Okada,Hirokazu Oyamada,Tetsuya Fujita,Hisahiro Norikae,Takashi Yasuda

doi:10.1038/s41598-021-81702-w

Hiroshi Okada, Takashi Nishi + Show 8 more

Open Access

https://doi.org/10.1038/s41598-021-81702-w

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Abstract

Cardiovascular disease (CVD) is still the major cause of mortality in patients with type 2 diabetes. Despite of recent therapies, mortality and resources spent on healthcare due to CVD is still important problem. Thus, appropriate markers are needed to predict poor outcomes. Therefore, we investigated the role of peripheral perfusion as an indicator for cardiovascular death in patients with type 2 diabetes and established CVD. This retrospective cohort study included 1080 patients with type 2 diabetes and history of CVD recruited from the outpatient clinic at Matsushita Memorial Hospital in Osaka, Japan. Peripheral perfusion is assessed using the perfusion index (PI), which represents the level of circulation through peripheral tissues. The median age and PI values were 74 years (range: 67–79 years) and 2.6% (range: 1.1–4.3%), respectively. During follow-up duration, 60 patients died due to CVD. The adjusted Cox regression analysis demonstrated that the risk of developing cardiovascular death was higher in the first quartile (Hazard ratio, 6.23; 95% CI, 2.28 to 22.12) or second quartile (Hazard ratio, 3.04; 95% CI, 1.46 to 6.85) of PI than that in the highest quartile (fourth quartile) of PI. PI (per 1% decrease) was associated with the development of cardiovascular death (Hazard ratio, 1.39; 95% CI, 1.16 to 1.68). PI could be a novel indicator of cardiovascular death in patients with type 2 diabetes and established CVD.

Highlights

Cardiovascular disease (CVD) is still the major cause of mortality in patients with type 2 diabetes
The major finding of our study is that perfusion index (PI), which represents peripheral perfusion is a novel indicator for cardiovascular death in patients with type 2 diabetes and established CVD
Lima et al.10 have found that patients who failed to normalize peripheral perfusion calculated by PI in the early phase of critical illnesses had a worse outcome

Summary

Introduction

Cardiovascular disease (CVD) is still the major cause of mortality in patients with type 2 diabetes. We investigated the role of peripheral perfusion as an indicator for cardiovascular death in patients with type 2 diabetes and established CVD. PI could be a novel indicator of cardiovascular death in patients with type 2 diabetes and established CVD. Cardiovascular disease (CVD) is the primary cause of mortality and morbidity in patients with type 2 diabetes, and several risk factors including smoking, hypertension and dyslipidemia have been shown to accelerate the progression of C VD1,2. Low value of PI was associated with adverse outcomes in the early phase of critical illnesses. There are no studies which reported the association between PI and the development of cardiovascular death in patients with type 2. We aimed to assess the association between PI and the development of cardiovascular death and the association between PI and cardiovascular death or recurrent cardiovascular events in patients with type 2 diabetes and established CVD

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