title: Comprehensive Interpretation of Central Venous Oxygen Saturation and Blood Lactate Levels During Resuscitation of Patients With Severe Sepsis and Septic Shock in the Emergency Department.
abstract: OBJECTIVE
  We evaluated central venous oxygen saturation (Scvo2) and lactate levels as a combination measure to predict mortality in patients with severe sepsis or septic shock.
  
  
  METHODS
  We included patients older than 18 years of age who presented to a single tertiary emergency center with septic shock or severe sepsis and received early goal-directed therapy. We classified the sample into four groups according to lactate (cut-off: 4 mmol/L) and Scvo2 (cut-off: 70%) levels at the time of initial resuscitation: Group 1, high-Scvo2, and low-lactate; Group 2, low-Scvo2, and low-lactate; Group 3, high-Scvo2, and high-lactate; Group 4, low-Scvo2, and high-lactate. The primary outcome was 28-day mortality determined by multivariable Cox-regression analysis.
  
  
  RESULTS
  A total of 880 patients were included in this study. The 28-day mortality was 6.7% in Group 1, 15.7% in Group 2, 26.7% in Group 3, and 25.5% in Group 4 (P < 0.01). Compared with Group 1, all other groups showed significant differences in mortality (P < 0.01 by the log-rank test). There was, however, no difference between Groups 3 and 4. Multivariable Cox regression analysis showed that all other groups exhibited significantly increased hazard ratios for 28-day mortality, compared with Group 1.
  
  
  CONCLUSIONS
  Oxygenation category, as represented by initial Scvo2 and lactate levels, was significantly associated with 28-day mortality in patients with severe sepsis or septic shock. Associations between Scvo2 ≥70% and 28-day survival were observed only in patients without severe lactic acidosis.
authors.affiliation: *Department of Emergency Medicine †Department of Critical Care Medicine, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, Korea.
authors.forename: Tae Gun
authors.initials: TG
authors.lastname: Shin
authors.forename: Ik Joon
authors.initials: IJ
authors.lastname: Jo
authors.forename: Sung Yeon
authors.initials: SY
authors.lastname: Hwang
authors.forename: Kyeongman
authors.initials: K
authors.lastname: Jeon
authors.forename: Gee Young
authors.initials: GY
authors.lastname: Suh
authors.forename: Euna
authors.initials: E
authors.lastname: Choe
authors.forename: Young Kun
authors.initials: YK
authors.lastname: Lee
authors.forename: Tae Rim
authors.initials: TR
authors.lastname: Lee
authors.forename: Won Chul
authors.initials: WC
authors.lastname: Cha
authors.forename: Min Seob
authors.initials: MS
authors.lastname: Sim
mesh_terms: D000368:Aged; D015415:Biomarkers / Q000097:blood; D015897:Comorbidity; D004636:Emergency Service, Hospital; D005260:Female; D006801:Humans; D053208:Kaplan-Meier Estimate; D019344:Lactic Acid / Q000097:blood*; D008297:Male; D008875:Middle Aged; D010100:Oxygen / Q000097:blood*; D010101:Oxygen Consumption / Q000502:physiology; D011379:Prognosis; D012042:Registries; D056910:Republic of Korea / Q000453:epidemiology; D012151:Resuscitation / Q000379:methods*; D018805:Sepsis / Q000097:blood / Q000175:diagnosis* / Q000401:mortality / Q000628:therapy; D012772:Shock, Septic / Q000097:blood / Q000175:diagnosis / Q000401:mortality / Q000628:therapy
chemical_list: D015415:Biomarkers; D019344:Lactic Acid; D010100:Oxygen