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[Venous-to-arterial carbon dioxide difference to arteriovenous oxygen content difference ratio combined with lactate to predict prognosis of patients with septic shock].
Zhonghua Nei Ke Za Zhi. 2016 Sep 01; 55(9):673-8.ZN

Abstract

OBJECTIVE

To investigate the prognostic significance of venous-to-arterial carbon dioxide difference to arteriovenous oxygen content difference ratio (Pv-aCO2/Ca-vO2 ratio) combined with lactate in patients with septic shock during the early phases of resuscitation.

METHODS

A retrospective study was conducted for 104 septic shock patients. All patients received an initial fluid resuscitation according to the Surviving Sepsis Campaign: International Guidelines for Management of Severe Sepsis and Septic Shock, 2012(SSC2012). Patients were classified into four groups according to lactate levels and Pv-aCO2/Ca-vO2 ratio at 6 h of resuscitation: group A, lactate≥2.0 mmol/L and Pv-aCO2/Ca-vO2>1.0; group B, lactate≥2.0 mmol/L and Pv-aCO2/Ca-vO2≤1.0; group C, lactate<2.0 mmol/L and Pv-aCO2/Ca-vO2>1.0; group D, lactate<2.0 mmol/L and Pv-aCO2/Ca-vO2≤1.0. The hemodynamic parameters and oxygen metabolism parameters were recorded at baseline and 6 h after fluid resuscitation. Sequential organ failure assessment (SOFA) score at day 1, day 3 were calculated. The 28-day mortality rate was recorded.

RESULTS

(1) Group A had the highest SOFA score at day 3 and group D the lowest, which were respectively 10.8±3.3, 6.7±3.6, 5.6±3.1, 4.1±2.2 in four groups. Accordingly, the 28-day mortality rate of group A was the highest and group D the lowest, which were respectively 83.3%, 59.1%, 60.0%, 14.3% in four groups. The differences were statistically significant (P<0.05). (2) The Cox regression analysis of 28 d mortality revealed that lactate levels (RR=4.306, 95%CI 1.979-9.369) and Pv-aCO2/Ca-vO2 ratio (RR=2.888, 95%CI 1.676-4.976) at T6 were independent predictors to 28-day mortality. (3) The AUCROC of Pv-aCO2/Ca-vO2 ratio combined with lactate [0.910(95%CI 0.857-0.963)] was significantly greater than the AUCROC of wither lactate [0.762(95%CI 0.673-0.852), Z=2.775; P=0.006) or Pv-aCO2/Ca-vO2 ratio [0.781(95%CI 0.693-0.868), Z=2.458; P=0.014) alone.

CONCLUSION

Combination of Pv-aCO2/Ca-vO2 ratio and lactate level at early stage of resuscitation in patients with septic shock is better than single parameter to predict the prognosis.

Authors+Show Affiliations

Department of Critial Care Medicine, Zhejiang Hospital, Hangzhou 310013, China.No affiliation info availableNo affiliation info availableNo affiliation info availableNo affiliation info availableNo affiliation info availableNo affiliation info availableNo affiliation info availableNo affiliation info available

Pub Type(s)

Journal Article

Language

chi

PubMed ID

27586973

Citation

Gong, S J., et al. "[Venous-to-arterial Carbon Dioxide Difference to Arteriovenous Oxygen Content Difference Ratio Combined With Lactate to Predict Prognosis of Patients With Septic Shock]." Zhonghua Nei Ke Za Zhi, vol. 55, no. 9, 2016, pp. 673-8.
Gong SJ, Song J, Zhou JD, et al. [Venous-to-arterial carbon dioxide difference to arteriovenous oxygen content difference ratio combined with lactate to predict prognosis of patients with septic shock]. Zhonghua Nei Ke Za Zhi. 2016;55(9):673-8.
Gong, S. J., Song, J., Zhou, J. D., Yu, Y. H., Dai, H. W., Wang, M. J., Li, L., Xu, Q. H., & Yan, J. (2016). [Venous-to-arterial carbon dioxide difference to arteriovenous oxygen content difference ratio combined with lactate to predict prognosis of patients with septic shock]. Zhonghua Nei Ke Za Zhi, 55(9), 673-8. https://doi.org/10.3760/cma.j.issn.0578-1426.2016.09.004
Gong SJ, et al. [Venous-to-arterial Carbon Dioxide Difference to Arteriovenous Oxygen Content Difference Ratio Combined With Lactate to Predict Prognosis of Patients With Septic Shock]. Zhonghua Nei Ke Za Zhi. 2016 Sep 1;55(9):673-8. PubMed PMID: 27586973.
* Article titles in AMA citation format should be in sentence-case
TY - JOUR T1 - [Venous-to-arterial carbon dioxide difference to arteriovenous oxygen content difference ratio combined with lactate to predict prognosis of patients with septic shock]. AU - Gong,S J, AU - Song,J, AU - Zhou,J D, AU - Yu,Y H, AU - Dai,H W, AU - Wang,M J, AU - Li,L, AU - Xu,Q H, AU - Yan,J, PY - 2016/9/3/entrez PY - 2016/9/3/pubmed PY - 2017/6/9/medline SP - 673 EP - 8 JF - Zhonghua nei ke za zhi JO - Zhonghua Nei Ke Za Zhi VL - 55 IS - 9 N2 - OBJECTIVE: To investigate the prognostic significance of venous-to-arterial carbon dioxide difference to arteriovenous oxygen content difference ratio (Pv-aCO2/Ca-vO2 ratio) combined with lactate in patients with septic shock during the early phases of resuscitation. METHODS: A retrospective study was conducted for 104 septic shock patients. All patients received an initial fluid resuscitation according to the Surviving Sepsis Campaign: International Guidelines for Management of Severe Sepsis and Septic Shock, 2012(SSC2012). Patients were classified into four groups according to lactate levels and Pv-aCO2/Ca-vO2 ratio at 6 h of resuscitation: group A, lactate≥2.0 mmol/L and Pv-aCO2/Ca-vO2>1.0; group B, lactate≥2.0 mmol/L and Pv-aCO2/Ca-vO2≤1.0; group C, lactate<2.0 mmol/L and Pv-aCO2/Ca-vO2>1.0; group D, lactate<2.0 mmol/L and Pv-aCO2/Ca-vO2≤1.0. The hemodynamic parameters and oxygen metabolism parameters were recorded at baseline and 6 h after fluid resuscitation. Sequential organ failure assessment (SOFA) score at day 1, day 3 were calculated. The 28-day mortality rate was recorded. RESULTS: (1) Group A had the highest SOFA score at day 3 and group D the lowest, which were respectively 10.8±3.3, 6.7±3.6, 5.6±3.1, 4.1±2.2 in four groups. Accordingly, the 28-day mortality rate of group A was the highest and group D the lowest, which were respectively 83.3%, 59.1%, 60.0%, 14.3% in four groups. The differences were statistically significant (P<0.05). (2) The Cox regression analysis of 28 d mortality revealed that lactate levels (RR=4.306, 95%CI 1.979-9.369) and Pv-aCO2/Ca-vO2 ratio (RR=2.888, 95%CI 1.676-4.976) at T6 were independent predictors to 28-day mortality. (3) The AUCROC of Pv-aCO2/Ca-vO2 ratio combined with lactate [0.910(95%CI 0.857-0.963)] was significantly greater than the AUCROC of wither lactate [0.762(95%CI 0.673-0.852), Z=2.775; P=0.006) or Pv-aCO2/Ca-vO2 ratio [0.781(95%CI 0.693-0.868), Z=2.458; P=0.014) alone. CONCLUSION: Combination of Pv-aCO2/Ca-vO2 ratio and lactate level at early stage of resuscitation in patients with septic shock is better than single parameter to predict the prognosis. SN - 0578-1426 UR - https://www.unboundmedicine.com/medline/citation/27586973/[Venous_to_arterial_carbon_dioxide_difference_to_arteriovenous_oxygen_content_difference_ratio_combined_with_lactate_to_predict_prognosis_of_patients_with_septic_shock]_ DB - PRIME DP - Unbound Medicine ER -