Department of Cardio-Thoracic Surgery, Drum Tower Hospital Clinical Medical College of Nanjing Medical University, Nanjing, Jiangsu, China.
Department of Cardio-Thoracic Surgery, Affiliated Drum Tower Hospital of Nanjing University Medical School, Nanjing, Jiangsu, China.
Shock. 2019 Dec;52(6):583-589. doi: 10.1097/SHK.0000000000001324.
In contrast to arterial lactate, previous studies have proposed central venous-to-arterial CO2 difference (P (v-a)CO2) as a more useful guide for categorizing patients at risk of developing septic shock. It is worthwhile studying P (v-a)CO2 in determining whether it could serve as a useful predictor for poor postoperative outcomes in patients undergoing cardiac surgery. We investigated the ability of P(v-a)CO2 to predict poor outcomes of patients with postoperative cardiogenic shock.
In total, 1,672 patients were enrolled in this study from January 1, 2014 to June 1, 2017. Of these patients, 143 exhibited complicated and poor outcomes. To address any bias, we derived a propensity score predicting the functions of P(v-a)CO2 on poor outcomes and matched 114 cases to 114 controls with a similar risk profile. In this cohort study, poor outcomes were defined as the occurrence of any adverse complications, including sudden death, cardiac arrest, extracorporeal membrane oxygenation, oliguria, and the administration of a large amount of vasoactive-inotropic drugs.
In propensity-matched patients, significant differences in P(v-a)CO2 (6.11 ± 2.94 mm Hg vs. 11.21 ± 5.22 mm Hg, P < 0.001) were noted between the control group and poor outcome group. The area under the receiver operating characteristic curve of P(v-a)CO2 (AUC: 0.837, 95% CI: 0.782-0.892) for the detection of poor outcomes was significantly better compared to that of the central venous oxygen saturation and arterial lactate. Additionally, there was a negative correlation between cardiac index and P(v-a)CO2 (R= -0.68, P < 0.001).
We have shown a correlation between P(v-a)CO2 to cardiac output which may be used as an alternative metric to predict the poor outcomes of patients with postoperative cardiogenic shock.
与动脉乳酸不同，先前的研究提出中心静脉至动脉二氧化碳差（P（v-a）CO2）作为一种更有用的分类工具，用于预测发生感染性休克的风险。研究 P（v-a）CO2 在确定其是否可作为心脏手术后患者不良术后结局的有用预测指标是值得的。我们研究了 P（v-a）CO2 预测术后心源性休克患者不良结局的能力。
本研究共纳入 2014 年 1 月 1 日至 2017 年 6 月 1 日期间的 1672 例患者，其中 143 例患者出现复杂和不良结局。为了消除任何偏倚，我们得出了一个预测 P（v-a）CO2 对不良结局的功能的倾向评分，并将 114 例病例与 114 例具有相似风险特征的对照进行了匹配。在这项队列研究中，不良结局定义为任何不良并发症的发生，包括突然死亡、心脏骤停、体外膜氧合、少尿和大剂量血管活性-正性肌力药物的使用。
在倾向匹配的患者中，对照组和不良结局组之间的 P（v-a）CO2 差异有统计学意义（6.11 ± 2.94 mmHg 与 11.21 ± 5.22 mmHg，P < 0.001）。P（v-a）CO2 检测不良结局的受试者工作特征曲线下面积（AUC：0.837，95%CI：0.782-0.892）明显优于中心静脉血氧饱和度和动脉乳酸。此外，心指数与 P（v-a）CO2 之间存在负相关（R = -0.68，P < 0.001）。
我们已经证明了 P（v-a）CO2 与心输出量之间存在相关性，这可能是一种替代指标，用于预测术后心源性休克患者的不良结局。
