Relationship between Dynamic Changes of Microcirculation Flow, Tissue Perfusion Parameters, and Lactate Level and Mortality of Septic Shock in ICU

Abstract

Background. Septic shock is a common clinical critical disease with high mortality, hemodynamic instability, and easy to be complicated with multiple organ failure. The rapid progress of the patient’s condition poses a serious threat to patient’s safety. Aim. To investigate the relationship between the dynamic monitoring of microcirculation perfusion parameters and blood lactic acid level and the prognosis of patients with infection shock in ICU. Methods. A total of 104 patients with septic shock admitted to ICU of Affiliated Hai’an Hospital of Nantong University from February 2018 to June 2021 were selected for clinical research. According to the survival situation of patients after 28 days of treatment, they were divided into the death group (n = 48) and the survival group (n = 56). The central venous-arterial carbon dioxide partial pressure difference (Pcv-aCO2), the ratio of central venous-arterial carbon dioxide partial pressure difference to arterial central venous oxygen content difference (Pcv-aCO2/Ca-cvO2), and blood lactic acid level were retrospectively analyzed and compared between the two groups on the first, third, and seventh days after admission to ICU. The odds ratio (OR) of three indexes affecting the prognosis of patients with septic shock was analyzed by univariate and multivariate mathematical models, and the value of three indexes in predicting the prognosis of patients was analyzed by receiver operating curve (ROC). Results. Pcv-aCO2 and lactic acid in the death group were higher than those in the survival group on the 1st, 3rd, and 7th day of ICU stay ( P < 0.05). The Pcv-aCO2/Ca-cvO2 of the death group was higher than that of the survival group on the 3rd and 7th day of ICU stay ( P < 0.05). Logistic model results showed that age, SOFA score, APACHE II score, the number of multiple organ failure (MODS), intracranial infection, the increase of Pcv-aCO2, Pcv-aCO2/Ca-cvO2, and the increase of lactic acid were independent risk factors for death in patients with septic shock (OR values were 1.519, 1.808, 1.781, 1.912, 2.069, 1.848, 1.781, and 1.642, respectively, P < 0.05). The results showed that the AUC value of Pcv-aCO2 in predicting death was 0.943, and the sensitivity and specificity were 93.72% and 83.09%, respectively. The AUC value of Pcv-aCO2/Ca-cvO2 for predicting death was 0.887, and the sensitivity and specificity were 81.63% and 77.56%, respectively. The AUC value of lactic acid in predicting death of patients was 0.825, and the sensitivity and specificity were 71.66% and 82.09%, respectively. Conclusion. Changes of microcirculation flow tissue perfusion parameters and blood lactic acid level changes are closely related to the prognosis of patients with septic shock, which is of great value in the evaluation of the prognosis of patients with septic shock.

The lactate to albumin ratio linked to all-cause mortality in critically ill patients with septic myocardial injury

“…Recent study has demonstrated a correlation between lactate levels and adverse outcomes in critically ill patients ( 25 ). Furthermore, research has indicated an association between elevated lactate levels and a poor prognosis in sepsis patients ( 26 ). Our study also observed elevated serum lactate levels in SMI patients with a poor prognosis.…”

Venous Minus Arterial Carbon Dioxide Gradients in the Monitoring of Tissue Perfusion and Oxygenation: A Narrative Review

“…Additionally, in 35 patients with septic shock, P cv-a CO 2 /C a-cv O 2 was a strong predictor of lactate behavior, and both variables were associated with mortality [90]. Recent studies also found a relationship of P cv-a CO 2 /C a-cv O 2 to mortality [91][92][93].…”

Terlipressin Combined With Norepinephrine in the Treatment of Septic Shock: A Systematic Review

“…However, some studies (43) have indicated that the combination of TP and NE does not improve microcirculation, suggesting that microcirculation is primarily influenced by factors such as patient volume status, resuscitation duration, and disease progression. The latest guidelines from the "Rescuing Sepsis Campaign" emphasize the importance of relying on microcirculation to guide resuscitation strategies, necessitating adjustments to existing treatment approaches and aiming for more accurate clinical predictions (44). The inconsistent results reported in the aforementioned studies can be attributed to variations in study subjects, conditions for evaluating microcirculation, and strategies used for TP infusion (45,46).…”