ArticleAnnals of intensive care2016
Toe-to-room temperature gradient correlates with tissue perfusion and predicts outcome in selected critically ill patients with severe infections.
Article in Annals of intensive care, 2016. The graph could read no effect estimate from its abstract, so it casts no vote on the map. Cited by 39 papers, 2 of them syntheses that pooled it.
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Who cites it
39 citing papers in PubMed, 2 syntheses or guidelines pooled it, 96 citations in OpenAlex.
- Prognostic value of capillary refill time in adult patients: a systematic review with meta-analysis.Critical care (London, England) · 2023Pooled it
- [Association between peripheral perfusion, microcirculation and mortality in sepsis: a systematic review].Brazilian journal of anesthesiology (Elsevier)Pooled it
- Development and external validation of a predictive model for in-hospital mortality in patients with liver cirrhosis and sepsis.Scientific reports · 2026Article
- Application of Infrared Thermography in Early Screening of Sepsis and Prediction of Septic Shock Risk: A Systematic Review.Emergency medicine international · 2026Review
- The Usefulness of Peripheral and Organ Perfusion Monitoring in Predicting Mortality in Patients with Severe SARS-CoV-2.Biomedicines · 2025Article
- The Predictive Value of Clinical Signs to Identify Shock in Critically Ill Patients.Diagnostics (Basel, Switzerland) · 2025Article
- Clinical Assessment of Fluid Status in Adults With Acute Kidney Injury: A Scoping Review.Journal of renal care · 2025Article
- Utility of core to peripheral temperature gradient using infrared thermography in the assessment of patients with sepsis and septic shock in the emergency medicine department.International journal of emergency medicine · 2025Article
- Relationship between skin microvascular blood flow and capillary refill time in critically ill patients.Critical care (London, England) · 2025Observational
- Peripheral and Organ Perfusion's Role in Prognosis of Disease Severity and Mortality in Severe COVID-19 Patients: Prospective Cohort Study.Journal of clinical medicine · 2024Article
- Early peripheral perfusion monitoring in septic shock.European journal of medical research · 2024Review
- Role of arterial blood glucose and interstitial fluid glucose difference in evaluating microcirculation and clinical prognosis of patients with septic shock: a prospective observational study.BMC infectious diseases · 2024Observational
- The Indian Society of Critical Care Medicine Position Statement on the Management of Sepsis in Resource-limited Settings.Indian journal of critical care medicine : peer-reviewed, official publication of Indian Society of Critical Care Medicine · 2024Article
- The use of thermal imaging for evaluation of peripheral tissue perfusion in surgical patients with septic shock.BMC anesthesiology · 2024Observational
- Infrared Thermography Imaging for Assessment of Peripheral Perfusion in Patients with Septic Shock.Bioengineering (Basel, Switzerland) · 2023Article
- Interpreting Infrared Thermography with Deep Learning to Assess the Mortality Risk of Critically Ill Patients at Risk of Hypoperfusion.Reviews in cardiovascular medicine · 2023Article
- Vitamin C improves microvascular reactivity and peripheral tissue perfusion in septic shock patients.Critical care (London, England) · 2022Article
- Early Prediction of Hemodynamic Shock in Pediatric Intensive Care Units With Deep Learning on Thermal Videos.Frontiers in physiology · 2022Article
- Endothelial Activation and Microcirculatory Disorders in Sepsis.Frontiers in medicine · 2022Review
- Assessment of Volume Status and Fluid Responsiveness in Small Animals.Frontiers in veterinary science · 2021Review
Corrections and comments
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Authors and funding
15 authors at 4 institutions in 2 countries.
Funding
No grant is acknowledged in the PubMed record.
Abstract
backgroundMicrocirculatory disorders leading to tissue hypoperfusion play a central role in the pathophysiology of organ failure in severe sepsis and septic shock. As microcirculatory disorders have been identified as strong predictive factors of unfavourable outcome, there is a need to develop accurate parameters at the bedside to evaluate tissue perfusion. We evaluated whether different body temperature gradients could relate to sepsis severity and could predict outcome in critically ill patients with severe sepsis and septic shock.
methodWe conducted a prospective observational study in a tertiary teaching hospital in France. During a 10-month period, all consecutive adult patients with severe sepsis or septic shock who required ICU admission were included. Six hours after initial resuscitation (H6), we recorded the hemodynamic parameters and four temperature gradients: central-to-toe, central-to-knee, toe-to-room and knee-to-room.
resultsWe evaluated 40 patients with severe sepsis (40/103, 39 %) and 63 patients with septic shock (63/103, 61 %). In patients with septic shock, central-to-toe temperature gradient was significantly higher (12.5 [9.2; 13.8] vs 6.9 [3.4; 12.0] °C, P < 0.001) and toe-to-room temperature gradient significantly lower (1.2 [-0.3; 5.2] vs 6.0 [0.6; 9.5] °C, P < 0.001) than in patients with severe sepsis. Overall ICU mortality rate due to multiple organ failure (MOF) was 21 %. After initial resuscitation, toe-to-room temperature gradient was significantly lower in patients dead from MOF than in the survivors (-0.2 [-1.1; +1.3] °C vs +3.9 [+0.5; +7.2] °C, P < 0.001) and the difference in gradients increased during the first 24 h. Furthermore, toe-to-room temperature gradient was related to tissue perfusion parameters such as arterial lactate level (r = -0.54, P < 0.0001), urine output (r = 0.37, P = 0.0002), knee capillary refill time (r = -0.42, P < 0.0001) and mottling score (P = 0.001).
conclusionsToe-to-room temperature gradient reflects tissue perfusion at the bedside and is a strong prognosis factor in critically ill patients with severe infections.
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