Comprehensive Interpretation of Central Venous Oxygen Saturation and Blood Lactate Levels During Resuscitation of Patients With Severe Sepsis and Septic Shock in the Emergency Department

Shin, T.Gun.; Jo, I.Joon.; Hwang, S.Yeon.; Jeon, K.; Suh, G.Young.; Choe, E.; Lee, Y.Kun.; Lee, T.Rim.; Cha, W.Chul.; Sim, M.Seob.

Shock 45(1): 4-9

2016


ISSN/ISBN: 1073-2322
PMID: 26674449
DOI: 10.1097/shk.0000000000000466
Accession: 057481377

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Abstract
We evaluated central venous oxygen saturation (Scvo2) and lactate levels as a combination measure to predict mortality in patients with severe sepsis or septic shock. We included patients older than 18 years of age who presented to a single tertiary emergency center with septic shock or severe sepsis and received early goal-directed therapy. We classified the sample into four groups according to lactate (cut-off: 4 mmol/L) and Scvo2 (cut-off: 70%) levels at the time of initial resuscitation: Group 1, high-Scvo2, and low-lactate; Group 2, low-Scvo2, and low-lactate; Group 3, high-Scvo2, and high-lactate; Group 4, low-Scvo2, and high-lactate. The primary outcome was 28-day mortality determined by multivariable Cox-regression analysis. A total of 880 patients were included in this study. The 28-day mortality was 6.7% in Group 1, 15.7% in Group 2, 26.7% in Group 3, and 25.5% in Group 4 (P < 0.01). Compared with Group 1, all other groups showed significant differences in mortality (P < 0.01 by the log-rank test). There was, however, no difference between Groups 3 and 4. Multivariable Cox regression analysis showed that all other groups exhibited significantly increased hazard ratios for 28-day mortality, compared with Group 1. Oxygenation category, as represented by initial Scvo2 and lactate levels, was significantly associated with 28-day mortality in patients with severe sepsis or septic shock. Associations between Scvo2 ≥70% and 28-day survival were observed only in patients without severe lactic acidosis.