title: [The application of combined central venous pressure and oxygen metabolism parameters monitoring in diagnosing septic shock-induced left ventricular dysfunction].
abstract: OBJECTIVE
  To evaluate the value of central venous pressure (CVP), central venous oxygen saturation (ScvO₂) and venous-arterial carbon dioxide partial pressure gradient (Pv-aCO₂)) in the diagnosis of septic shock-induced left ventricular dysfunction.
  
  
  METHODS
  Consecutive patients with septic shock were enrolled from September 2013 to September 2014 in ICU at Peking Union Medical College Hospital. The data of CVP, Pv-aCO₂) and ScvO₂) were recorded and analyzed. According to the left ventricular ejection fraction (LVEF) tested by bedside echocardiography, the patients were divided into two groups: new onset of left ventricular dysfunction (LVEF < 50%) group and non-left ventricular dysfunction (LVEF ≥ 50%) group. A diagnostic model was created by logistic regression. The diagnostic performance and cut-off values of CVP, Pv-aCO₂, ScvO₂) were determined using receiver operating characteristic (ROC) curve analysis.
  
  
  RESULTS
  Among 93 patients enrolled, 39 were diagnosed with left ventricular dysfunction. In the new onset group, CVP [(12.5 ± 3.9) mmHg (1 mmHg = 0.133 kPa) vs (10.4 ± 2.5) mmHg; P = 0.005] and Pv-aCO₂[(7.5 ± 3.9) mmHg vs (4.5 ± 2.6) mmHg; P < 0.001] were significantly higher than those in the non-left ventricular dysfunction group, while Scv2 [(62.4 ± 10.5)% vs (72.6 ± 9.0)%; P < 0.001] was significantly lower. As far as the diagnostic value of these three parameters were concerned for left ventricular dysfunction, the sensitivity of CVP ≥ 12.5 mmHg was 46.2%, specificity 81.5% with an area under ROC curve (AUCROC) 0.674; the sensitivity of Pv-aCO₂≥ 5.0 mmHg 76.9%, specificity 37.0%, AUCROC 0.738; the sensitivity of ScvO₂≤ 65.8% 64.1%, specificity 78.6%, AUCROC 0.775. When the cut-off values were determined by ROC, the diagnostic performance of the model was ≥ 0.377 with the sensitivity, specificity and AUCROC 82.1%, 79.6% and 0.835, respectively.
  
  
  CONCLUSIONS
  In patients with septic shock, the logistic regression model established by CVP, Pv-aCO₂and ScvO₂contributes to the diagnosis of septic shock-induced left ventricular dysfunction.
authors.affiliation: Department of Critical Care Medicine, Peking Union Medical College Hospital, Peking Union Medical College, Chinese Academy of Medical Sciences, Beijing 100730, China.
authors.forename: Keliang
authors.initials: K
authors.lastname: Cui
authors.affiliation: Department of Critical Care Medicine, Peking Union Medical College Hospital, Peking Union Medical College, Chinese Academy of Medical Sciences, Beijing 100730, China.
authors.forename: Xiaoting
authors.initials: X
authors.lastname: Wang
authors.affiliation: Department of Critical Care Medicine, Peking Union Medical College Hospital, Peking Union Medical College, Chinese Academy of Medical Sciences, Beijing 100730, China.
authors.forename: Hongmin
authors.initials: H
authors.lastname: Zhang
authors.affiliation: Department of Critical Care Medicine, Peking Union Medical College Hospital, Peking Union Medical College, Chinese Academy of Medical Sciences, Beijing 100730, China.
authors.forename: Wenzhao
authors.initials: W
authors.lastname: Chai
authors.affiliation: Department of Critical Care Medicine, Peking Union Medical College Hospital, Peking Union Medical College, Chinese Academy of Medical Sciences, Beijing 100730, China; Email: dwliu@medmail.com.cn.
authors.forename: Dawei
authors.initials: D
authors.lastname: Liu
mesh_terms: D000068476:Beijing; D002496:Central Venous Pressure; D006801:Humans; D010100:Oxygen; D011659:Pulmonary Gas Exchange; D012772:Shock, Septic / Q000150:complications*; D018487:Ventricular Dysfunction, Left / Q000175:diagnosis* / Q000209:etiology
chemical_list: D010100:Oxygen