Wang Xueting, Gao Xuehua, Cao Wen, Guan Yin, Luo Yannian, Lian Foyan, He Nannan, Li Peijie
Department of Critical Care Medicine, Lanzhou University Second Hospital, Lanzhou 730030, Gansu, China. Corresponding author: Li Peijie, Email:
Zhonghua Wei Zhong Bing Ji Jiu Yi Xue. 2020 Jan;32(1):39-43. doi: 10.3760/cma.j.cn121430-20191226-00007.
To evaluate the prognostic value of arterial lactate (Lac) combined with central venous-to-arterial carbon dioxide difference to arterial-to-central venous oxygen content difference ratio (Pcv-aCO/Ca-cvO) in patients with septic shock following early fluid resuscitation.
A total of 97 patients with septic shock admitted to intensive care unit (ICU) of Lanzhou University Second Hospital from January 2017 to December 2019 were enrolled. The Pcv-aCO/Ca-cvO ratio was calculated from blood gas analysis of radial artery and superior vena cava which was performed before resuscitation and at 6 hours of resuscitation at the same time. The patients were divided into death group and survival group according to the 28-day prognosis. The baseline data, acute physiology and chronic health evaluation II (APACHE II) score, sequential organ failure score (SOFA), clinical therapy, lactate clearance rate (LCR) at 6 hours, the length of ICU stay, hemodynamics and oxygen metabolism parameters before and after resuscitation were compared between the two groups. Risk factors were analyzed by multivariate Cox regression for 28-day mortality of patients with septic shock. The receiver operating characteristic (ROC) curve was plotted to assess the prognostic values of these factors for 28-day mortality.
(1) Compared with the survival group, the patients in the death group showed significantly higher levels of APACHE II score (23.96±4.31 vs. 17.70±3.92) and SOFA score (12.74±2.80 vs. 9.23±2.43, both P < 0.01), significantly higher proportions of mechanical ventilation [85.2% (23/27) vs. 50.0% (35/70)] and continuous renal replacement therapy [CRRT; 51.9% (14/27) vs. 25.7% (18/70), both P < 0.05], a significantly more fluid replacement at 6 hours (L: 2.92±0.24 vs. 2.63±0.25, P < 0.01), a significantly lower level of LCR at 6 hours [(11.61±7.76)% vs. (27.67±13.71)%, P < 0.01], and a shorter length of ICU stay (days: 6.37±2.70 vs. 7.67±2.31, P < 0.05). (2) Compared with the survival group, the patients before resuscitation in the death group showed a significantly lower level of mean arterial pressure [MAP (mmHg, 1 mmHg = 0.133 kPa): 52.63±4.35 vs. 55.74±3.01, P < 0.01], significantly higher levels of Lac and Pcv-aCO/Ca-cvO ratio [Lac (mmol/L): 7.13±1.75 vs. 5.22±1.36, Pcv-aCO/Ca-cvO ratio: 1.67±0.29 vs. 1.48±0.22, both P < 0.01]; and the patients at 6 hours of resuscitation in the death group showed a significantly lower level of MAP (mmHg: 62.59±4.80 vs. 66.71±3.91, P < 0.01), significantly higher levels of central venous pressure (CVP), Lac, Pcv-aCO and Pcv-aCO/Ca-cvO ratio [CVP (mmHg): 10.74±1.40 vs. 8.80±0.75, Lac (mmol/L): 6.36±1.86 vs. 3.90±1.95, Pcv-aCO (mmHg): 7.59±2.02 vs. 4.34±1.37, Pcv-aCO/Ca-cvO ratio: 1.87±0.51 vs. 1.03±0.27, all P < 0.01]. (3) Multivariate Cox regression analysis showed that the independent risk factors for 28-day mortality in patients with septic shock were Lac and Pcv-aCO/Ca-cvO ratio whether before or at 6 hours of resuscitation [Lac before resuscitation: relative risk (RR) = 1.434, 95% confidence interval (95%CI) was 1.070-1.922, P = 0.016; Lac at 6 hours of resuscitation: RR = 1.564, 95%CI was 1.202-2.035, P = 0.001; Pcv-aCO/Ca-cvO ratio before resuscitation: RR = 2.828, 95%CI was 1.108-4.207, P = 0.038; Pcv-aCO/Ca-cvO ratio at 6 hours of resuscitation: RR = 4.386, 95%CI was 2.842-5.730, P = 0.000]. (4) ROC curve analysis showed that Lac and Pcv-aCO/Ca-cvO ratio at 6 hours of resuscitation had predictive value for the prognosis of patients with septic shock, the area under ROC curve (AUC) was 0.849 (95%CI was 0.762-0.914) and 0.905 (95%CI was 0.828-0.955), respectively. However, the predictive value of Lac combined with Pcv-aCO/Ca-cvO ratio in patients with septic shock was significantly higher than Lac [AUC (95%CI): 0.976 (0.923-0.996) vs. 0.849 (0.762-0.914), Z = 3.354, P = 0.001], the sensitivity was 97.14%, and the specificity was 88.89%.
Lac and Pcv-aCO/Ca-cvO ratio are independent risk factors for predicting 28-day mortality in patients with septic shock. Lac combined with Pcv-aCO/Ca-cvO ratio can assess the prognosis of patients with septic shock more accurately.
评估早期液体复苏后动脉血乳酸（Lac）联合中心静脉血与动脉血二氧化碳分压差和动脉血氧含量与中心静脉血氧含量差值之比（Pcv-aCO/Ca-cvO）对感染性休克患者的预后价值。
选取2017年1月至2019年12月在兰州大学第二医院重症监护病房（ICU）收治的97例感染性休克患者。在复苏前及复苏6小时时同时采集桡动脉和上腔静脉血进行血气分析，计算Pcv-aCO/Ca-cvO比值。根据28天预后将患者分为死亡组和存活组。比较两组患者的基线资料、急性生理与慢性健康状况评分系统II（APACHE II）评分、序贯器官衰竭评分（SOFA）、临床治疗情况、复苏6小时时的乳酸清除率（LCR）、ICU住院时间、复苏前后的血流动力学及氧代谢参数。采用多因素Cox回归分析感染性休克患者28天死亡的危险因素。绘制受试者工作特征（ROC）曲线评估这些因素对28天死亡率的预后价值。
（1）与存活组相比，死亡组患者的APACHE II评分（23.96±4.31比17.70±3.92）和SOFA评分（12.74±2.80比9.23±2.43，均P<0.01）显著更高，机械通气比例[85.2%（23/27）比50.0%（35/70）]和持续肾脏替代治疗[CRRT；51.9%（14/27）比25.7%（18/70），均P<0.05]显著更高，复苏6小时时补液量显著更多（升：2.92±0.24比2.63±0.25，P<0.01），复苏6小时时LCR显著更低[（11.61±7.76）%比（27.67±13.71）%，P<0.01]，ICU住院时间更短（天：6.37±2.70比7.67±2.31，P<0.05）。（2）与存活组相比，死亡组复苏前患者的平均动脉压[MAP（mmHg，1 mmHg = 0.133 kPa）：52.63±4.35比55.74±3.01，P<0.01]显著更低，Lac和Pcv-aCO/Ca-cvO比值显著更高[Lac（mmol/L）：7.13±1.75比5.22±1.36，Pcv-aCO/Ca-cvO比值：1.67±0.29比1.48±0.22，均P<0.01]；死亡组复苏6小时时患者的MAP显著更低（mmHg：62.59±4.80比66.71±3.91，P<0.01），中心静脉压（CVP）、Lac、Pcv-aCO和Pcv-aCO/Ca-cvO比值显著更高[CVP（mmHg）：10.74±1.40比8.80±0.75，Lac（mmol/L）：6.36±1.86比3.90±1.95，Pcv-aCO（mmHg）：
