INTRODUCTION: As technological advances allow for the development of more sophisticated measurement of the mechanisms that contribute to compensation for loss of circulating blood volume such as @entity548 , it is important to compare the discriminative ability of these new measures to standard vital signs and other new physiologic metrics of interest. The purpose of this study was to compare the discriminative ability of the following three measures to predict the onset of hemodynamic decompensation: peripheral perfusion index (PPI), pulse pressure variability ( @entity2286 ), and the compensatory reserve index (CRI). MATERIALS AND METHODS: There were 51 healthy @entity1 who underwent a progressive simulated @entity548 to induce central @entity3485 by lower body negative pressure (LBNP). The least-squares means and 95% confidence intervals for each measure were reported by LBNP level and stratified by tolerance status (high tolerance vs. low tolerance). Generalized estimating equations were used to perform repeated measures logistic regression analysis by regressing the onset of hemodynamic decompensation on each of the vital signs of interest. These probabilities were used to calculate sensitivity, specificity, and receiver-operating characteristic area under the curve (ROCAUC) for PPI, @entity2286 , and CRI. RESULTS: Compared with both @entity2286 (ROCAUC=0.79) and PPI (0.56), the CRI (0.90) had superior discriminative ability (P <=0.0001) to predict the onset of hemodynamic decompensation. This included higher sensitivity (0.86 vs. 0.78 and 0.71) and specificity (0.78 vs. 0.69 and 0.29) for the CRI compared with @entity2286 and PPI, respectively. Further, CRI was the only measure with mean predicted probabilities of the onset of hemodynamic decompensation that progressively increased as the level of simulated @entity548 increased. DISCUSSION: There are two potential rationales for why the CRI had superior discriminative ability to predict hemodynamic decompensation. First, the CRI more accurately predicted the onset of hemodynamic decompensation at all levels of simulated @entity548 , but especially at lower levels of @entity548 . Second, the CRI was better able to differentiate high versus low tolerant @entity1 . CONCLUSION: Consistent with previous research, the CRI had superior discriminative ability to predict the onset of hemodynamic decompensation. For those @entity1 at greatest risk for developing impending @entity1457 , identifying the most sensitive and specific measures of the onset of hemodynamic decompensation is critical for both the early recognition and implementation of life-saving interventions.

Predictors of the Onset of Hemodynamic Decompensation XXXX : Comparison of the Peripheral Perfusion Index, Pulse Pressure Variability, and Compensatory Reserve Index.

@entity1 :: ('9606', 'Species') :: ['participants', 'patients'] @entity548 :: ('MESH:D006470', 'Disease') :: ['hemorrhage'] @entity1457 :: ('MESH:D012769', 'Disease') :: ['circulatory shock'] @entity2286 :: ('12211', 'Species') :: ['PPV'] @entity3485 :: ('MESH:D020896', 'Disease') :: ['hypovolemia']
@entity3485 :: (MESH:D020896,Disease) :: ['During Progressive Central Hypovolemia']
