Vellinga NA Boerma EC Koopmans M Donati A Dubin A Shapiro NI Pearse RM Machado FR Fries M Akarsu-Ayazoglu T Pranskunas A Hollenberg S Balestra G van Iterson M van der Voort PH Sadaka F Minto G Aypar U Hurtado FJ Martinelli G Payen D van Haren F Holley A Pattnaik R Gomez H Mehta RL Rodriguez AH Ruiz C Canales HS Duranteau J Spronk PE Jhanji S Hubble S Chierego M Jung C Martin D Sorbara C Tijssen JG Bakker J Ince C 2015 OBJECTIVES Microcirculatory alterations are associated with adverse outcome in subsets of critically ill patients. The prevalence and significance of microcirculatory alterations in the general ICU population are unknown. We studied the prevalence of microcirculatory alterations in a heterogeneous ICU population and its predictive value in an integrative model of macro- and microcirculatory variables. DESIGN Multicenter observational point prevalence study. SETTING The Microcirculatory Shock Occurrence in Acutely ill Patients study was conducted in 36 ICUs worldwide. PATIENTS A heterogeneous ICU population consisting of 501 patients. INTERVENTIONS None. MEASUREMENTS AND MAIN RESULTS Demographic, hemodynamic, and laboratory data were collected in all ICU patients who were 18 years old or older. Sublingual Sidestream Dark Field imaging was performed to determine the prevalence of an abnormal capillary microvascular flow index (< 2.6) and its additional value in predicting hospital mortality. In 501 patients with a median Acute Physiology and Chronic Health Evaluation II score of 15 (10-21), a Sequential Organ Failure Assessment score of 5 (2-8), and a hospital mortality of 28.4%, 17% exhibited an abnormal capillary microvascular flow index. Tachycardia (heart rate > 90 beats/min) (odds ratio, 2.71; 95% CI, 1.67-4.39; p < 0.001), mean arterial pressure (odds ratio, 0.979; 95% CI, 0.963-0.996; p = 0.013), vasopressor use (odds ratio, 1.84; 95% CI, 1.11-3.07; p = 0.019), and lactate level more than 1.5 mEq/L (odds ratio, 2.15; 95% CI, 1.28-3.62; p = 0.004) were independent risk factors for hospital mortality, but not abnormal microvascular flow index. In reference to microvascular flow index, a significant interaction was observed with tachycardia. In patients with tachycardia, the presence of an abnormal microvascular flow index was an independent, additive predictor for in-hospital mortality (odds ratio, 3.24; 95% CI, 1.30-8.06; p = 0.011). This was not true for nontachycardic patients nor for the total group of patients. CONCLUSIONS In a heterogeneous ICU population, an abnormal microvascular flow index was present in 17% of patients. This was not associated with mortality. However, in patients with tachycardia, an abnormal microvascular flow index was independently associated with an increased risk of hospital death. https://sonar.ch/global/documents/232567 eng info:eu-repo/semantics/altIdentifier/doi/10.1097/CCM.0000000000000553 info:eu-repo/semantics/altIdentifier/pmid/25126880 Critical care medicine. - 2015 APACHE Aged Blood Pressure Critical Illness Female Hemodynamics Hospital Mortality Humans Intensive Care Units Male Microcirculation Middle Aged Prevalence Risk Factors Shock Tachycardia International study on microcirculatory shock occurrence in acutely ill patients. http://purl.org/coar/resource_type/c_6501