ABSTRACT
Background: To determine whether Pcv-aCO2/Ca-cvO2 combined with Pcv-aCO2 could predict the outcomes in patients complicated with abdominal infection and sepsis after abdominal tumor operation. Methods: Total 92 patients admitted to our hospital from January 2017 to December 2020 who underwent abdominal tumor operation were enrolled. Blood gas analysis of artery and central vein, various laboratory indexes, SOFA score, hemodynamic parameters at different time points and treatment outcome were recorded. Results: ROC curve analysis showed that hemodynamic parameter alone could not predict ICU treatment outcome and mortality of patients, but 72-hour SOFA score could predict treatment outcome of patients (AUC = 0.930, 95% CI: 0.803-1.000, p = 0.019). The significant hemodynamic parameter for evaluating treatment outcome and prognosis of patients was Pcv-aCO2 + Ratio of T3. Kaplan-Meier univariate survival curve and Log-rank suggested that patients who had higher combined predictive parameter of T3 Ratio + T3 Pcv-aCO2 still had ischemia and hypoxia of tissues and organs after standard fluid resuscitation, and treatment outcome was not good. In subgroup analysis, patients with higher Ratio had higher lactate, higher T72 SOFA score, and poor treatment outcome. Conclusion: The combination of Ratio and Pcv-aCO2 could evaluate clinical treatment outcome of patients complicated with abdominal infection and sepsis after abdominal tumor operation.
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. CONCLUSION: 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.
