Use of peripheral perfusion index (PI) as a predictor of cardiovascular complications in hospitalised Covid 19 patients - A pilot study


  • Aparna Menon
  • Divya R.



Covid-19, perfusion index, cardiovascular complications


Introduction and Aim: Cardiovascular complications have been associated with fatality in Covid-19 patients. Reduced peripheral perfusion is a marker for cardiovascular dysfunction.  Peripheral Perfusion Index (PI) is a non-invasive measure of microvascular perfusion with regards to pulsatile arterial blood flow. The study was aimed at finding the utility of PI as a hemodynamic marker in Covid-19.


Materials and Methods: Observational study done on 58 hospitalised adult Covid-19 patients over a span of 6 days. Each day the hemodynamic parameters such as pulse rate, SpO2 and Peripheral Perfusion Index (PI) were measured using a finger pulse oximeter. Peripheral Blood pressure was measured using automated BP apparatus. Mean Arterial Pressure (MAP) and pulse pressure (PP) was calculated.


Results: Correlation between PI and other parameters checked using Pearson’s test. There was significant positive correlation between PI and PP in day wise analysis during first 2 days with linear regression showing PP can be predicted as a dependant function from PI. This shows the association between PI and systemic cardiovascular function.


Conclusion: PI is a useful measure of peripheral microvascular perfusion and relates to systemic PP. It can be predicted from the results that PI can act as a reliable guide to predict the cardiovascular condition of the patient. As PI is measured from finger pulse oximeter, it is a non-invasive and easy-to-record method, which can be used by untrained personnel in Covid-19 patients.

Author Biographies

Aparna Menon

Department of Physiology, Dhanalakshmi Srinivasan Medical College, and Hospital, Perambalur, Tamil Nadu, India

Divya R.

Department of Physiology, Dhanalakshmi Srinivasan Medical College, and Hospital, Perambalur, Tamil Nadu, India


WHO. Covid 19 pandemic. Available from:[Accessed:2022/01/14]

MoHFW. Home. Available from: [Accessed:2022/01/14]

Panagides, V., Vincent, F., Weizman, O., Jonveaux, M., Trimaille, A., Pommier, T., et al., History of heart failure in patients with coronavirus disease 2019: Insights from a French registry. Arch Cardiovasc Dis., 2021; 114(5): 415-425. DOI:

Harrison, S, L., Buckley, B.J.R., Rivera-caravaca, M., Zhang, J., Lip, G.Y.H. OUP accepted manuscript. Eur Hear J - Qual Care Clin Outcomes. 2021; 1-10.

Boerma, E. C., Bethlehem, C., Stellingwerf, F., De Lange, F., Streng, K.W., Koetsier, P.M., et al., Hemodynamic characteristics of mechanically ventilated covid-19 patients: A Cohort Analysis. Crit Care Res Pract. 2021; 2021:1-7 DOI:

Delorey, T.M., Ziegler, C.G.K., Heimberg, G., Normand, R., Yang, Y., Segerstolpe, A., et al., COVID-19 tissue atlases reveal SARS-CoV-2 pathology and cellular targets. Nature 2021; Available from: pubmed/33915569

Magro, C., Mulvey, J.J., Berlin, D., Nuovo, G., Salvatore, S., Harp, J., et al., Complement associated microvascular injury and thrombosis in the pathogenesis of severe COVID-19 infection: A report of five cases. 2020; 220:1-13 DOI:

Haubner, B., Tanner, F.C., Ruschitzka, F., Flammer, A.J., Matthias, P.N., Endothelial dysfunction in COVID-19: current findings and therapeutic implications. Atherosclerosis. 2020; 314:58-62. DOI:

Cecconi, M., De Backer, D., Antonelli, M., Beale, R., Bakker, J., Hofer, C., et al., Consensus on circulatory shock and hemodynamic monitoring. Task force of the European Society of Intensive Care Medicine. Intensive Care Med. 2014;40(12):1795-1815. DOI:

Szekely, Y., Lichter, Y., Taieb, P., Banai, A., Hochstadt, A., Merdler, I., et al., Spectrum of cardiac manifestations in COVID-19: A Systematic echocardiographic study. Circulation. 2020; 142(4): 342-353. DOI:

Yi, Y., Xu, Y., Jiang, H., Wang, J. Cardiovascular Disease and COVID-19: Insight from Cases with Heart Failure. Front Cardiovasc Med. 2021; 8:1-6. DOI:

Hasanin, A., Mukhtar, A., Nassar, H. Perfusion indices revisited. J Intensive Care. 2017;5(1):1-8. DOI:

Sabioni, L., Lorenzo, A. D., Lamas, C., Muccillo, F. Systemic microvascular endothelial dysfunction and disease severity in COVID-19 patients: Evaluation by laser Doppler perfusion monitoring and cytokine/chemokine analysis. Microvascular research. 2021;134: 104119 DOI:

Lima, A.P., Beelen, P., Bakker, J. Use of a peripheral perfusion index derived from the pulse oximetry signal as a noninvasive indicator of perfusion. Crit Care Med. 2002; 30(6):1210-1213. DOI:

Das, M., Bardakci, O., Siddikoglu, D., Akdur, G., Yilmaz, M.C., Akdur, O., et al., Prognostic performance of peripheral perfusion index and shock index combined with ESI to predict hospital outcome. Am J Emerg Med. 2020; 38(10):2055-2059. DOI:

Michard, F., Shelley, K., L’Her, E. Covid-19: Pulse oximeters in the spotlight. J Clin Monit Comput. 2021; 35(1):11-14. DOI:

Sharma, Y.P., Agstam, S., Yadav, A., Gupta, A., Gupta, A. Cardiovascular manifestations of COVID-19: An evidence-based narrative review. Indian J Med Res.2021;153: 7-16. DOI:

Mok, J., Malpartida, J.C., O'Dell, K., Davis, J., Gao, C., Manyam, H. Vascular comorbidities worsen prognosis of patients with heart failure hospitalised with COVID-19. Open Heart. 2021;8(1): e001668. DOI:

Ji, Y., Ma, Z., Peppelenbosch, M.P., Pan, Q. Potential association between COVID-19 mortality and health-care resource availability. Lancet Glob Health. 2020; 8(4): e480. DOI:

Ozakin, E., Yazlamaz, N.O., Kaya, F.B., Karakilic, E.M., Bilgin, M. Perfusion index measurement in predicting hypovolemic shock in trauma patients. J Emerg Med. 2020; 59(2):238-245. DOI:

Ismail, J., Sankar, J. Peripheral Perfusion Index – Magic wand in prediction of shock? Indian J Pediatr. 2019; 86(10):879-880. DOI:

Sivaprasath, P., Mookka, Gounder, R., Mythili, B. Prediction of shock by peripheral perfusion index. Indian J Pediatr. 2019; 86(10):903-908. DOI:

Shi, X., Xu, M., Yu, X., Lu, Y. Peripheral perfusion index predicting prolonged ICU stay earlier and better than lactate in surgical patients: An observational study. BMC Anesthesiol. 2020; 20(1):1-9. DOI:

Agerskov, M., Thusholdt, A.N.W., Hojlund, J., Meyhoff, C.S., Sorensen, H., Wiberg, S., et al., Protocol for a multicentre retrospective observational cohort study in Denmark: Association between the intraoperative peripheral perfusion index and postoperative morbidity and mortality in acute non-cardiac surgical patients. BMJ Open. 2019; 9(11): 1-6. DOI:

Yokose, M., Mihara, T., Takaya, M., Yamamoto, T., Saigusa, Y., Takaki, S., et al., The perfusion index measured by the pulse oximeter affects the agreement between ClearSight and the arterial catheter-based blood pressures: A prospective observational study.PLoS One. 2019;14(7):1-11. DOI:

Er, M.C., Kaya, C., Ustun, Y.B., Sahinoglu, A.H. Predictive value of perfusion index for mortality in mechanically ventilated patients. Aging Male. 2021; 23(5): 1251-1258. DOI:




How to Cite

Menon A, R. D. Use of peripheral perfusion index (PI) as a predictor of cardiovascular complications in hospitalised Covid 19 patients - A pilot study. Biomedicine [Internet]. 2022 Nov. 14 [cited 2022 Nov. 27];42(5):1008-13. Available from:



Original Research Articles

Plum Analytics