Rusnak Jonas, Schupp Tobias, Weidner Kathrin, Ruka Marinela, Egner-Walter Sascha, Schmitt Alexander, Akin Muharrem, Mashayekhi Kambis, Ayoub Mohamed, Behnes Michael, Akin Ibrahim
Department of Cardiology, Angiology, Haemostaseology and Medical Intensive Care, University Medical Centre Mannheim, Medical Faculty Mannheim, Heidelberg University, Mannheim, Germany.
First Department of Medicine, University Medical Center Mannheim (UMM), Theodor-Kutzer-Ufer 1-3, 68167, Mannheim, Germany.
Intern Emerg Med. 2025 Jun;20(4):1077-1086. doi: 10.1007/s11739-025-03926-2. Epub 2025 May 9.
In patients with acute cardiovascular diseases, hypocapnia, hypoxia and hyperoxia are known to be associated with increased mortality. This monocentric prospective registry study included 238 consecutive patients with cardiogenic shock (CS). The study aimed to assess the prognostic impact of partial arterial carbon dioxide (PaCO) and oxygen pressure (PaO) on 30-day all-cause mortality. Statistical analyses included t-tests, Spearman´s correlation, Kaplan-Meier and Cox regression analyses. No difference was found between quartiles of PaCO (log-rank p = 0.416) and PaO (log-rank p = 0.946) in the entire cohort. In the subgroup of patients with ventilation on admission, patients with PaCO ≤ 33 mmHg showed the highest 30-day all-cause mortality compared to the other quartiles (82.6% vs. 46.9% vs. 54.0% vs. 59.6% log-rank p = 0.026). No differences were found between levels of PaO, when stratified by quartiles (log-rank p = 0.895). After differentiation between patients with PaCO ≤ 33 mmHg and PaCO > 33 mmHg the association with 30-day all-cause mortality remained significant (82.6% vs. 54.5% log-rank p = 0.006) in ventilated patients, whereas still no difference could be seen in the entire cohort (log-rank p = 0.264). Even after multivariable adjustment PaCO ≤ 33 mmHg remained an independent risk factor for 30-day all-cause mortality (HR 1.936; 95% CI 1.131-3.316; p = 0.016) in ventilated CS-patients. In conclusion, no association was found between different levels of PaCO and PaO with 30-day all-cause mortality in patients with CS. However, in the subgroup of CS-patients requiring ventilation, PaCO ≤ 33 mmHg was associated with an increased 30-day all-cause mortality.
在急性心血管疾病患者中，已知低碳酸血症、低氧血症和高氧血症与死亡率增加有关。这项单中心前瞻性登记研究纳入了238例连续的心源 性休克（CS）患者。该研究旨在评估动脉血二氧化碳分压（PaCO）和氧分压（PaO）对30天全因死亡率的预后影响。统计分析包括t检验、Spearman相关性分析、Kaplan-Meier分析和Cox回归分析。在整个队列中，PaCO四分位数（对数秩p = 0.416）和PaO四分位数（对数秩p = 0.946）之间未发现差异。在入院时接受通气的患者亚组中，与其他四分位数相比，PaCO≤33 mmHg的患者30天全因死亡率最高（82.6% 对vs . 46.9% vs . 54.0% vs . 59.6%；对数秩p = 0.026）。按四分位数分层时，PaO水平之间未发现差异（对数秩p = 0.895）。在区分PaCO≤33 mmHg和PaCO>33 mmHg的患者后，通气患者中与30天全因死亡率的关联仍然显著（82.6% 对vs . 54.5%；对数秩p = 0.006），而在整个队列中仍未发现差异（对数秩p = 0.264）。即使在多变量调整后，PaCO≤33 mmHg在通气的CS患者中仍然是30天全因死亡率的独立危险因素（HR 1.936；95% CI 1 . A131 - 3.316；p = 0.016）。总之，在CS患者中，不同水平的PaCO和PaO与30天全因死亡率之间未发现关联。然而，在需要通气的CS患者亚组中，PaCO≤33 mmHg与30天全因死亡率增加有关。
