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.
OBJECTIVE
Several studies reported Pv-aCO2/Ca-vO2ratio as a surrogate of VCO2/VO2to detect global tissue hypoxia. The present study aimed to evaluate the prognostic value of Pv-aCO2/Ca-vO2ratio 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-vO2ratio>1.4 was considered abnormal. Patients were classified into four predefined groups according to lactate levels and Pv-aCO2/Ca-vO2ratio 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-vO2ratio and Pv-aCO2/Ca-vO2ratio combined with lactate to predict mortality at day 28.


RESULTS
Combination of hyperlactatemia and high Pv-aCO2/Ca-vO2ratio 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-vO2ratio and lactate at T6 were independent predictors of mortality at day 28. The area under the ROC curve of the Pv-aCO2/Ca-vO2ratio combined with lactate for predicting mortality at day 28 was highest and superior to that of lactate and Pv-aCO2/Ca-vO2ratios.


CONCLUSIONS
Combination of Pv-aCO2/Ca-vO2ratio and lactate at early stages of resuscitation of septic shock can better predict the prognosis of patients. The Pv-aCO2/Ca-vO2ratio may become a useful parameter supplementary to lactate in the resuscitation of septic shock.
Department of General Surgery, Zhejiang Hospital, Hangzhou, Zhejiang 310013, China.
Juandi
J
Zhou
Department of Critical Care Medicine, Zhejiang Hospital, Hangzhou, Zhejiang 310013, China.
Jia
J
Song
Department of Critical Care Medicine, Zhejiang Hospital, Hangzhou, Zhejiang 310013, China. Electronic address: gsj801@126.com.
Shijin
S
Gong
Department of Critical Care Medicine, Zhejiang Hospital, Hangzhou, Zhejiang 310013, China.
Li
L
Li
Department of Critical Care Medicine, Zhejiang Hospital, Hangzhou, Zhejiang 310013, China.
Haixiang
H
Zhang
Department of Critical Care Medicine, Zhejiang Hospital, Hangzhou, Zhejiang 310013, China.
Minjia
M
Wang
D000368:Aged; D001784:Blood Gas Analysis; D002245:Carbon Dioxide / Q000378:metabolism*; D002681:China; D003422:Critical Care; D005260:Female; D006801:Humans; D065906:Hyperlactatemia / Q000378:metabolism* / Q000503:physiopathology; D008297:Male; D063305:Organ Dysfunction Scores; D010101:Oxygen Consumption; D011379:Prognosis; D012372:ROC Curve; D012151:Resuscitation; D012189:Retrospective Studies; D012772:Shock, Septic / Q000378:metabolism* / Q000503:physiopathology / Q000628:therapy*
D002245:Carbon Dioxide
Acute circulatory failure; Anaerobic metabolism; CO(2) gap; Lactate; Respiratory quotient; Septic shock; Tissue hypoxia