Abstract
BACKGROUND: Sepsis is life-threatening due to organ dysfunction from a dysregulated host response. Despite macrohemodynamic stabilisation, microcirculatory disturbances may persist. Capillary refill time (CRT) is a simple bedside indicator of microcirculatory perfusion, but its dynamic prognostic value over time is underexplored. AIM: To observe CRT changes in sepsis patients and evaluate its predictive value at different time points. STUDY DESIGN: This prospective cohort study enrolled sepsis patients receiving bundle therapy at a single centre. Patients were grouped by 28-day survival. Baseline data, CRT, lactate (Lac) and central venous pressure (CVP) were measured at eight time points (pre-treatment to 72 h) compare inter-group and intra-group differences. Spearman's correlation assessed CRT-Lac/CVP relationships. ROC analysis evaluated CRT's prognostic value. RESULTS: Of 86 patients (70 survived, 16 non-survivors), significant inter-group differences (p < 0.05) were found in age, SOFA score, lactate and vasoactive drug dosage. CRT and Lac differed significantly between groups at all time points (p < 0.05), while CVP differed at 3, 24 and 72 h. Intra-group comparisons showed significant changes in all parameters over time (p < 0.01). CRT correlated negatively with CVP in survivors (r = -0.358, p < 0.001). In non-survivors, CRT positively correlated with Lac and negatively with CVP (r = 0.416 and -0.553, both p < 0.001). ROC analysis indicated 3-h post-treatment CRT had the highest predictive value (AUC = 0.981, sensitivity 93.8%, specificity 97.1%). Spearman correlation analysis revealed a positive correlation between ΔCRT₃h and ΔLac₃h in both patient groups: ρ = 0.25, p = 0.035 in the survival group and ρ = 0.52, p < 0.001 in the non-survival group. CONCLUSIONS: CRT is a valuable prognostic marker in sepsis, with 3-h CRT showing the strongest predictive performance. Its monitoring may guide early treatment decisions. RELEVANCE TO CLINICAL PRACTICE: This study validates nurse-measured capillary refill time (CRT) as a simple, early-warning tool. A prolonged 3-h CRT accurately identifies high-risk septic patients, enabling nurses to prioritise care and guide timely resuscitation at the bedside.