Mark Dustin G, Morehouse John W, Hung Yun-Yi, Kene Mamata V, Elms Andrew R, Liu Vincent, Ballard Dustin W, Vinson David R
Crit Care. 2014 Sep 12;18(5):496. doi: 10.1186/s13054-014-0496-y.
We sought to investigate whether treatment of subnormal (<70%) central venous oxygen saturation (ScvO2) with inotropes or red blood cell (RBC) transfusion during early goal-directed therapy (EGDT) for septic shock is independently associated with in-hospital mortality.
Retrospective analysis of a prospective EGDT patient database drawn from 21 emergency departments with a single standardized EGDT protocol. Patients were included if, during EGDT, they concomitantly achieved a central venous pressure (CVP) of ≥8 mm Hg and a mean arterial pressure (MAP) of ≥65 mm Hg while registering a ScvO2 < 70%. Treatment propensity scores for either RBC transfusion or inotrope administration were separately determined from independent patient sub-cohorts. Propensity-adjusted logistic regression analyses were conducted to test for associations between treatments and in-hospital mortality.
Of 2,595 EGDT patients, 572 (22.0%) met study inclusion criteria. The overall in-hospital mortality rate was 20.5%. Inotropes or RBC transfusions were administered for an ScvO2 < 70% to 51.9% of patients. Patients were not statistically more likely to achieve an ScvO2 of ≥70% if they were treated with RBC transfusion alone (29/59, 49.2%, P = 0.19), inotropic therapy alone (104/226, 46.0%, P = 0.15) or both RBC and inotropic therapy (7/12, 58.3%, P = 0.23) as compared to no therapy (108/275, 39.3%). Following adjustment for treatment propensity score, RBC transfusion was associated with a decreased adjusted odds ratio (aOR) of in-hospital mortality among patients with hemoglobin values less than 10 g/dL (aOR 0.42, 95% CI 0.18 to 0.97, P = 0.04) while inotropic therapy was not associated with in-hospital mortality among patients with hemoglobin values of 10 g/dL or greater (aOR 1.16, 95% CI 0.69 to 1.96, P = 0.57).
Among patients with septic shock treated with EGDT in the setting of subnormal ScvO2 values despite meeting CVP and MAP target goals, treatment with RBC transfusion may be independently associated with decreased in-hospital mortality.
我们试图研究在脓毒性休克的早期目标导向治疗（EGDT）期间，使用血管活性药物或输注红细胞（RBC）来治疗低于正常水平（<70%）的中心静脉血氧饱和度（ScvO2）是否与住院死亡率独立相关。
对来自21个急诊科的前瞻性EGDT患者数据库进行回顾性分析，采用单一标准化EGDT方案。如果患者在EGDT期间，同时达到中心静脉压（CVP）≥8 mmHg和平均动脉压（MAP）≥65 mmHg，且ScvO2 < 70%，则纳入研究。分别从独立的患者亚组中确定输注RBC或使用血管活性药物的治疗倾向评分。进行倾向调整的逻辑回归分析，以检验治疗与住院死亡率之间的关联。
在2595例EGDT患者中，572例（22.0%）符合研究纳入标准。总体住院死亡率为20.5%。51.9%的患者因ScvO2 < 70%接受了血管活性药物或RBC输注。与未接受治疗的患者（108/275，39.3%）相比，仅接受RBC输注治疗（29/59，49.2%，P = 0.19）、仅接受血管活性药物治疗（104/226，46.0%，P = 0.15）或同时接受RBC和血管活性药物治疗（7/12，58.3%，P = 0.23）的患者，ScvO2≥70%的可能性在统计学上并无显著差异。在调整治疗倾向评分后，对于血红蛋白值低于10 g/dL的患者，输注RBC与住院死亡率调整后的比值比（aOR）降低相关（aOR 0.42，95%CI 0.18至0.97，P = 0.04），而对于血红蛋白值为10 g/dL或更高的患者，血管活性药物治疗与住院死亡率无关（aOR 1.16，95%CI 0.69至1.96，P = 0.57）。
在EGDT治疗的脓毒性休克患者中，尽管达到了CVP和MAP目标值，但ScvO2值仍低于正常水平，输注RBC治疗可能与降低住院死亡率独立相关。
