Department of Medicine, Universidad de La Sabana. Chia Cundinamarca. Bogotá DC, Colombia.
Critical Medicine and Intensive Care, Msc Mechanical Ventilation and Respiratory Support, Department of Investigation, Fundación Clínica Shaio. Bogota DC. Colombia.
J Intensive Care Med. 2024 Apr;39(4):358-367. doi: 10.1177/08850666231208433. Epub 2023 Oct 24.
Oxygen debt (DEOx) represents the disparity between resting and shock oxygen consumption (VO) and is associated with metabolic insufficiency, acidosis, severity, and mortality. This study aimed to assess the reliability of DEOx as an indirect quantitative measure for predicting multiple organ dysfunction syndrome (MODS) and 28-day mortality in patients admitted to the intensive care unit (ICU) with respiratory syndrome severe acute coronavirus type 2 (SARS-CoV-2) infection, in comparison to the Acute Physiology and Chronic Health Evaluation II (APACHE II), sepsis-related organ failure assessment (SOFA), and 4C scores. A retrospective cohort study was conducted, including ICU patients with SARS-CoV-2 infection between 2020 and 2021. Clinical data were extracted from the EPIMED Monitor Database®. APACHE II, SOFA, and 4C scores were calculated upon ICU admission, and their accuracy in predicting 28-day mortality and MODS was compared to DEOx. Multivariate logistic regression analysis was performed to analyze the outcome variables. 708 patients were included, with a mortality rate of 44.4%. DEOx value was 11.16 ml O2/kg. The mean age was 58.7 years. Multivariate analysis showed that DEOx was independently associated with mortality, intubation, and renal injury. Each point increase in creatinine was associated with a higher risk of MODS. To determine the precision of the scores, area under the receiver operating characteristic curves (AUROC) analysis was performed with weak discrimination and similar behavior for the primary outcomes. The most accurate scale for mortality and MODS was 4C with an AUC of 0.683 and APACHE II with an AUC of 0.814, while that of the AUROC of DEOx was 0.612 and 0.646, respectively. DEOx showed similar predictive value to established scoring systems in critically ill patients with SARS-CoV-2 infection. The correlation of DEOx with these scores may facilitate early intervention in critically ill patients.
氧债（DEOx）代表静息和休克时氧消耗之间的差异，与代谢不足、酸中毒、严重程度和死亡率有关。本研究旨在评估 DEOx 作为一种间接定量测量指标，预测因严重急性冠状病毒 2 型（SARS-CoV-2）感染而入住重症监护病房（ICU）的患者发生多器官功能障碍综合征（MODS）和 28 天死亡率的可靠性，与急性生理学和慢性健康评估 II（APACHE II）、脓毒症相关器官衰竭评估（SOFA）和 4C 评分进行比较。这是一项回顾性队列研究，纳入了 2020 年至 2021 年间因 SARS-CoV-2 感染而入住 ICU 的患者。临床数据从 EPIMED Monitor Database®提取。APACHE II、SOFA 和 4C 评分在 ICU 入院时计算，并比较其预测 28 天死亡率和 MODS 的准确性与 DEOx。采用多变量逻辑回归分析对结局变量进行分析。纳入了 708 例患者，死亡率为 44.4%。DEOx 值为 11.16ml O2/kg。平均年龄为 58.7 岁。多变量分析显示，DEOx 与死亡率、插管和肾损伤独立相关。血肌酐每增加 1mg/dL，MODS 的风险就会增加。为了确定评分的准确性，进行了接受者操作特征曲线（AUROC）下面积分析，结果显示主要结局的区分度较低，行为相似。死亡率和 MODS 最准确的评分是 4C，AUC 为 0.683，APACHE II 为 0.814，而 DEOx 的 AUC 分别为 0.612 和 0.646。DEOx 在 SARS-CoV-2 感染的危重症患者中显示出与既定评分系统相似的预测价值。DEOx 与这些评分的相关性可能有助于对危重症患者进行早期干预。
