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Persistent hyperlactatemia-high central venous-arterial carbon dioxide to arterial-venous oxygen content ratio is associated with poor outcomes in early resuscitation of septic shock.
Am J Emerg Med. 2017 Aug; 35(8):1136-1141.AJ

Abstract

OBJECTIVE

Several studies reported Pv-aCO2/Ca-vO2 ratio as a surrogate of VCO2/VO2 to detect global tissue hypoxia. The present study aimed to evaluate the prognostic value of Pv-aCO2/Ca-vO2 ratio combined with lactate levels during the early phases of resuscitation in septic shock.

METHODS

A retrospective study was conducted in 144 septic shock patients in a 30-bed mixed ICU. A Pv-aCO2/Ca-vO2 ratio>1.4 was considered abnormal. Patients were classified into four predefined groups according to lactate levels and Pv-aCO2/Ca-vO2 ratio after the first 6h of resuscitation. Sequential Organ Failure Assessment (SOFA) score at day 3 was assessed. A Kaplan-Meier curve showed the survival probabilities at day 28 using a log-rank test to evaluate the differences between groups. A receiver operating characteristics (ROC) curve evaluated the ability of lactate, Pv-aCO2/Ca-vO2 ratio and Pv-aCO2/Ca-vO2 ratio combined with lactate to predict mortality at day 28.

RESULTS

Combination of hyperlactatemia and high Pv-aCO2/Ca-vO2 ratio was associated with poor SOFA scores and low survival rates at day 28 (P<0.001). The Cox multivariate survival analysis demonstrated that Pv-aCO2/Ca-vO2 ratio and lactate at T6 were independent predictors of mortality at day 28. The area under the ROC curve of the Pv-aCO2/Ca-vO2 ratio combined with lactate for predicting mortality at day 28 was highest and superior to that of lactate and Pv-aCO2/Ca-vO2 ratios.

CONCLUSION

Combination of Pv-aCO2/Ca-vO2 ratio and lactate at early stages of resuscitation of septic shock can better predict the prognosis of patients. The Pv-aCO2/Ca-vO2 ratio may become a useful parameter supplementary to lactate in the resuscitation of septic shock.

Authors+Show Affiliations

Department of General Surgery, Zhejiang Hospital, Hangzhou, Zhejiang 310013, China.Department of Critical Care Medicine, Zhejiang Hospital, Hangzhou, Zhejiang 310013, China.Department of Critical Care Medicine, Zhejiang Hospital, Hangzhou, Zhejiang 310013, China. Electronic address: gsj801@126.com.Department of Critical Care Medicine, Zhejiang Hospital, Hangzhou, Zhejiang 310013, China.Department of Critical Care Medicine, Zhejiang Hospital, Hangzhou, Zhejiang 310013, China.Department of Critical Care Medicine, Zhejiang Hospital, Hangzhou, Zhejiang 310013, China.

Pub Type(s)

Journal Article
Observational Study

Language

eng

PubMed ID

28341187

Citation

Zhou, Juandi, et al. "Persistent Hyperlactatemia-high Central Venous-arterial Carbon Dioxide to Arterial-venous Oxygen Content Ratio Is Associated With Poor Outcomes in Early Resuscitation of Septic Shock." The American Journal of Emergency Medicine, vol. 35, no. 8, 2017, pp. 1136-1141.
Zhou J, Song J, Gong S, et al. Persistent hyperlactatemia-high central venous-arterial carbon dioxide to arterial-venous oxygen content ratio is associated with poor outcomes in early resuscitation of septic shock. Am J Emerg Med. 2017;35(8):1136-1141.
Zhou, J., Song, J., Gong, S., Li, L., Zhang, H., & Wang, M. (2017). Persistent hyperlactatemia-high central venous-arterial carbon dioxide to arterial-venous oxygen content ratio is associated with poor outcomes in early resuscitation of septic shock. The American Journal of Emergency Medicine, 35(8), 1136-1141. https://doi.org/10.1016/j.ajem.2017.03.027
Zhou J, et al. Persistent Hyperlactatemia-high Central Venous-arterial Carbon Dioxide to Arterial-venous Oxygen Content Ratio Is Associated With Poor Outcomes in Early Resuscitation of Septic Shock. Am J Emerg Med. 2017;35(8):1136-1141. PubMed PMID: 28341187.
* Article titles in AMA citation format should be in sentence-case
TY - JOUR T1 - Persistent hyperlactatemia-high central venous-arterial carbon dioxide to arterial-venous oxygen content ratio is associated with poor outcomes in early resuscitation of septic shock. AU - Zhou,Juandi, AU - Song,Jia, AU - Gong,Shijin, AU - Li,Li, AU - Zhang,Haixiang, AU - Wang,Minjia, Y1 - 2017/03/14/ PY - 2017/01/08/received PY - 2017/03/13/accepted PY - 2017/3/28/pubmed PY - 2017/10/21/medline PY - 2017/3/26/entrez KW - Acute circulatory failure KW - Anaerobic metabolism KW - CO(2) gap KW - Lactate KW - Respiratory quotient KW - Septic shock KW - Tissue hypoxia SP - 1136 EP - 1141 JF - The American journal of emergency medicine JO - Am J Emerg Med VL - 35 IS - 8 N2 - OBJECTIVE: Several studies reported Pv-aCO2/Ca-vO2 ratio as a surrogate of VCO2/VO2 to detect global tissue hypoxia. The present study aimed to evaluate the prognostic value of Pv-aCO2/Ca-vO2 ratio combined with lactate levels during the early phases of resuscitation in septic shock. METHODS: A retrospective study was conducted in 144 septic shock patients in a 30-bed mixed ICU. A Pv-aCO2/Ca-vO2 ratio>1.4 was considered abnormal. Patients were classified into four predefined groups according to lactate levels and Pv-aCO2/Ca-vO2 ratio after the first 6h of resuscitation. Sequential Organ Failure Assessment (SOFA) score at day 3 was assessed. A Kaplan-Meier curve showed the survival probabilities at day 28 using a log-rank test to evaluate the differences between groups. A receiver operating characteristics (ROC) curve evaluated the ability of lactate, Pv-aCO2/Ca-vO2 ratio and Pv-aCO2/Ca-vO2 ratio combined with lactate to predict mortality at day 28. RESULTS: Combination of hyperlactatemia and high Pv-aCO2/Ca-vO2 ratio was associated with poor SOFA scores and low survival rates at day 28 (P<0.001). The Cox multivariate survival analysis demonstrated that Pv-aCO2/Ca-vO2 ratio and lactate at T6 were independent predictors of mortality at day 28. The area under the ROC curve of the Pv-aCO2/Ca-vO2 ratio combined with lactate for predicting mortality at day 28 was highest and superior to that of lactate and Pv-aCO2/Ca-vO2 ratios. CONCLUSION: Combination of Pv-aCO2/Ca-vO2 ratio and lactate at early stages of resuscitation of septic shock can better predict the prognosis of patients. The Pv-aCO2/Ca-vO2 ratio may become a useful parameter supplementary to lactate in the resuscitation of septic shock. SN - 1532-8171 UR - https://www.unboundmedicine.com/medline/citation/28341187/Persistent_hyperlactatemia_high_central_venous_arterial_carbon_dioxide_to_arterial_venous_oxygen_content_ratio_is_associated_with_poor_outcomes_in_early_resuscitation_of_septic_shock_ L2 - https://linkinghub.elsevier.com/retrieve/pii/S0735-6757(17)30190-0 DB - PRIME DP - Unbound Medicine ER -