A Prospective Clinical Study of Dynamic Pcv-aCO2 and Pcv-aCO2/Ca-cvO2 Ratio Monitoring in Evaluating the Prognosis of Patients with Septic Shock
Objective To investigate the value of central venous-arterial carbon dioxide partial pressure differ-ence(Pcv-aCO2),the ratio of central venous-arterial carbon dioxide partial pressure difference to arterial-cen-tral venous oxygen content difference(Pcv-aCO2/Ca-cvO2)and lactate in the prognostic assessment of septic shock.Methods A total of 90 patients with septic shock admitted to the ICU of General Hospital of Ningxia Medical University from October 2018 to December 2020,and their general clinical data were recorded.The central venous and peripheral arterial blood gas analysis data were dynamically record on the first,second,third,and fifth day after the patient entered the ICU.After 28 days of follow-up,the patients were divided into survivors group(58 cases)and a non-survivors group(32 cases)based on their survival status.Logistic regres-sion was used to analyze the prognostic factors of patients with septic shock.The predictive value of acute phys-iology and chronic health evaluation Ⅱ(APACHEⅡ)scores,lactate,and Pcv-aCO2 were analyzed for prognosis at 24 h after admission using the receiver operating characteristic(ROC)curve.Results ScvO2 was signifi-cantly lower in the septic shock non-survivors group than in the survivors group on days 2 and 3 of admission to the ICU(P<0.05).Pcv-aCO2 was significantly higher than that in the survivors group on days 2 and 3 of admis-sion to the ICU(P<0.05).The lactate values on days 1,2 and 3 of ICU admission were higher in the non-sur-vivors group than those in the survivors group(Pall<0.05).The levels of Pcv-aCO2/Ca-cvO2 at any time point of ICU stay were not significantly different between the non-survivors group and survivors group(P all>0.05).The differences in ScvO2,lactate and Pcv-aCO2 on day 5 of admission to ICU were not statistically significant in both groups(Pall>0.05).Univariate analysis and forward stepwise logistic regression analysis were performed using the 28-day mortality as the primary endpoint in septic shock patients.The findings showed that Pcv-aCO2 on day 2(OR=1.153,95％CI:1.005-1.323),Pcv-aCO2 on Day 3(OR=1.369,95％CI:1.030-1.819)and APACHE Ⅱ score on day 1 of ICU admission(OR=1.565,95％CI:1.285-1.906)were independent risk factors for mortality in patients with septic shock(P<0.05).ROC curve analysis revealed that Pcv-aCO2 on Day 3 of ICU admission combined with APACHE Ⅱ score has a higher predictive value in 28-Day mortality of septic shock patients(AUC=0.727,P<0.001).Conclusion Pcv-aCO2,blood lactic acid and ScVO2 are better than Pcv-a-CO2/Ca-cvO2 in reflecting the severity and prognosis of septic shock.The persistence of high Pcv-aCO2 is of greater value in predicting the prognosis of septic shock.
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