Venous-to-Arterial Carbon Dioxide Partial Pressure Difference: Predictor of Septic Patient Prognosis Depending on Central Venous Oxygen Saturation

Ronflé, Romain; Lefèbvre, Laurent; Duclos, Gary; Rambaud, Romain; Baumstarck, Karine; Daviet, Florence; Baldési, Olivier; Papazian, Laurent; Léone, Marc

doi:10.1097/shk.0000000000001442

Cited by 10 publications

(11 citation statements)

References 36 publications

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“…To determine diagnostic values, we assessed ROC curves and areas under the receiver operating characteristic curves (AUCs) to discriminate SIMD from sepsis and predict 28day mortality. The best cut-off value was identified as serum Lcn10 levels present the greatest total of sensitivity and specificity by the Youden index (J) method [20]. The positive predictive value (PPV) and negative predictive value (NPV) were calculated as follows:…”

Section: Discussionmentioning

confidence: 99%

Lipocalin 10 as a New Prognostic Biomarker in Sepsis-Induced Myocardial Dysfunction and Mortality: A Pilot Study

Wang

Xie

et al. 2021

Mediators of Inflammation

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Introduction. Sepsis-induced myocardial dysfunction (SIMD) is the most common complications of sepsis and septic shock with extremely high incidence and mortality. Lipocalin 10 (Lcn10) has recently been identified as a potential biomarker for heart failure, yet its relation to sepsis has not been investigated. The purpose of this study was to explore whether circulating Lcn10 could be used as a prognostic tool in patients with SIMD. Methods. In this single-center observational pilot study, seventy-five sepsis patients were enrolled after sepsis diagnosis or ICU admission (45.3% female, median age 60 years), and 35 patients (46.7%) developed myocardial dysfunction. Serum Lcn10 levels of septic patients were measured using the enzyme-linked immunosorbent assay (ELISA) at the time of admission. Other biomarkers of cardiac function and Lcn10 concentration were compared between SIMD and non-SIMD groups. Results. We observed that the median Lcn10 levels were 2.780 ng/mL in patients with SIMD and 2.075 ng/mL in patients without SIMD ( P < 0.05 ). The area under the receiver operating characteristic (ROC) curve for the diagnosis of SIMD was 0.797 ( P < 0.05 ). In addition, elevated serum Lcn10 levels at the time of admission were positively associated with 28-day mortality in septic patients. Conclusions. Our study indicates that circulating Lcn10 levels may serve as a novel biomarker for the diagnosis and prognosis of myocardial dysfunction induced by sepsis. An additional large multicenter study may be warranted to confirm the findings of this study.

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Section: Discussionmentioning

confidence: 99%

Lipocalin 10 as a New Prognostic Biomarker in Sepsis-Induced Myocardial Dysfunction and Mortality: A Pilot Study

Wang

Xie

et al. 2021

Mediators of Inflammation

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“…Moreover, serum lactate concentration at T6 was not associated with ΔSOFA ≥ 1. Interestingly, we previously showed that lactate clearance was similar in patients with tissue hypoxia with or without achieving ΔSOFA ≥ 1 20 . Finally, the usefulness of the serum lactate level was more suitable in association with another tissue hypoxia factor 38 .…”

Section: Discussionmentioning

confidence: 90%

“…The data were gathered upon ICU admission (T0), 6 hours after admission (T6), 12 hours after (T12), 24 hours after (T24), 48 hours after (T48) and 72 hours after (T72). Hemodynamic variables were included as in our previous study 20 . The Simpli ed Acute Physiology Score (SAPS II) was collected upon admission 21 .…”

Section: Measurements and Study Designmentioning

confidence: 99%

“…The hidden groups (states) were the patients' latent phenotypes. The variables included in the HMM were primarily based on domain knowledge and a literature review, in addiction with those collected for our study as de ned previously 15,20,29,30 . We chose to build the HMM for 3 phenotypes for it was the most relevant for the patient outcomes analysis.…”

Section: Measurements and Study Designmentioning

confidence: 99%

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Septic Shock: Phenotypes and Outcomes

et al. 2022

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Our goal was to determine the relevant variables and patient phenotypes to predict sepsis outcomes. We performed an ancillary study concerning 119 patients from three intensive care units (ICUs) in septic shock at ICU admittance (T0). We de ned clinical worsening as having an increased Sequential Organ Failure Assessment (SOFA) score ≥ 1 48 hours after admission (ΔSOFA ≥ 1). We performed univariate and multivariate analyses according to 28-day mortality rate and ΔSOFA ≥ 1, and determined three patient phenotypes: safe, intermediate and poor. Persistence of the intermediate and poor phenotypes after T0 were de ned as poor outcomes. At T0, the multivariate analysis showed two variables associated with 28-day mortality rate: norepinephrine dose and serum lactate concentration. Regarding ΔSOFA ≥ 1, we identi ed three variables at T0: norepinephrine dose, serum lactate concentration and venous-to-arterial carbon dioxide partial pressure difference (P(v-a)CO 2 ). At T0, the three phenotypes (safe, intermediate, and poor) were distributed in 28 (24%), 70 (59%) and 21 (18%) patients, respectively.We thus suggested an algorithm featuring norepinephrine dose, serum lactate concentration and P(va)CO 2 to predict patient outcomes and obtained an area under the curve (AUC) of 74% (63-85%). In conclusion, our ndings underline that identifying relevant variables and phenotypes may help physicians recognize patient outcomes.

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“…A clinical example for this could be in the event of hyperventilation in response to metabolic acidosis secondary to tissue hypoxia 21 in patients with intact respiratory drive, which could acutely affect the ∆PCO 2 , causing even higher values than the low flow state of tissue hypoxia itself, leading to misinterpretation of patient prognosis. 3 The interpretation of this parameter becomes particularly tricky when narrow cut-off values of ∆PCO 2 or similar indices, for example, the ∆PCO 2 /∆tO 2 ratio, are used. The ∆PCO 2 /∆tO 2 ratio has been shown to be a good marker for global anaerobic metabolism and fluid responsiveness.…”

Section: Discussionmentioning

confidence: 99%

Changes in central venous to arterial carbon dioxide gap (PCO₂gap) in response to acute changes in ventilation

et al. 2021

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BackgroundEarly diagnosis of shock is a predetermining factor for a good prognosis in intensive care. An elevated central venous to arterial PCO2 difference (∆PCO2) over 0.8 kPa (6 mm Hg) is indicative of low blood flow states. Disturbances around the time of blood sampling could result in inaccurate calculations of ∆PCO2, thereby misrepresenting the patient status. This study aimed to determine the influences of acute changes in ventilation on ∆PCO2 and understand its clinical implications.MethodsTo investigate the isolated effects of changes in ventilation on ∆PCO2, eight pigs were studied in a prospective observational cohort. Arterial and central venous catheters were inserted following anaesthetisation. Baseline ventilator settings were titrated to achieve an EtCO2 of 5±0.5 kPa (VT = 8 mL/kg, Freq = 14 ± 2/min). Blood was sampled simultaneously from both catheters at baseline and 30, 60, 90, 120, 180 and 240 s after a change in ventilation. Pigs were subjected to both hyperventilation and hypoventilation, wherein the respiratory frequency was doubled or halved from baseline. ∆PCO2 changes from baseline were analysed using repeated measures ANOVA with post-hoc analysis using Bonferroni’s correction.Results∆PCO2 at baseline for all pigs was 0.76±0.29 kPa (5.7±2.2 mm Hg). Following hyperventilation, there was a rapid increase in the ∆PCO2, increasing maximally to 1.35±0.29 kPa (10.1±2.2 mm Hg). A corresponding decrease in the ∆PCO2 was seen following hypoventilation, decreasing maximally to 0.23±0.31 kPa (1.7±2.3 mm Hg). These changes were statistically significant from baseline 30 s after the change in ventilation.ConclusionDisturbances around the time of blood sampling can rapidly affect the PCO2, leading to inaccurate calculations of the ∆PCO2, resulting in misinterpretation of patient status. Care should be taken when interpreting blood gases, if there is doubt as to the presence of acute and transient changes in ventilation.

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Venous-to-Arterial Carbon Dioxide Partial Pressure Difference: Predictor of Septic Patient Prognosis Depending on Central Venous Oxygen Saturation

Cited by 10 publications

References 36 publications

Lipocalin 10 as a New Prognostic Biomarker in Sepsis-Induced Myocardial Dysfunction and Mortality: A Pilot Study

Lipocalin 10 as a New Prognostic Biomarker in Sepsis-Induced Myocardial Dysfunction and Mortality: A Pilot Study

Septic Shock: Phenotypes and Outcomes

Changes in central venous to arterial carbon dioxide gap (PCO₂gap) in response to acute changes in ventilation

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Venous-to-Arterial Carbon Dioxide Partial Pressure Difference: Predictor of Septic Patient Prognosis Depending on Central Venous Oxygen Saturation

Cited by 10 publications

References 36 publications

Lipocalin 10 as a New Prognostic Biomarker in Sepsis-Induced Myocardial Dysfunction and Mortality: A Pilot Study

Lipocalin 10 as a New Prognostic Biomarker in Sepsis-Induced Myocardial Dysfunction and Mortality: A Pilot Study

Septic Shock: Phenotypes and Outcomes

Changes in central venous to arterial carbon dioxide gap (PCO2gap) in response to acute changes in ventilation

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Product

Resources

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Changes in central venous to arterial carbon dioxide gap (PCO₂gap) in response to acute changes in ventilation