Evaluation of the septic severity and prognosis by the combination of the partial pressure of carbon dioxide/oxygen content difference of venous and arterial with lactate clearance
Objective To analyze the relationship of the partial pressure of carbon dioxide/oxygen content difference of venous and arterial(Pcv-aCO2/Ca-vO2)with lactate clearance(LCR)during resuscitation,and to explore the value of Pcv-aCO2/Ca-vO2 combined with LCR in evaluating the severity and prognosis of sepsis.Methods 92 patients with sepsis underwent central venous and arterial blood gas analysis at admission and 6h after resuscitation.Pcv-aCO2/Ca-vO2 and LCR were calculated.According to Pcv-aCO2/Ca-vO2 and LCR values,the patient were divided into three groups:group A(Pcv-aCO2/Ca-vO2<1.4 and LCR≥10%,n =38),Group B(Pcv-aCO2/Ca-vO2<1.4 and LCR<10%,n =36),Group C(Pcv-aCO2/Ca-vO2≥1.4,n =18).The general conditions,severity of disease and prognostic indicators of the three groups were compared,and the correlation analysis was performed.ROC curve was drawn to predict the prognosis.Results There were statistically significant differences(P<0.05)in the acute physio-logical and chronic health assessment system(APACHEII)scores,heart rate at admission and 6 hours after resuscitation,the levels of bilirubin and creatinine after admission among the three groups.The sequential organ failure assessment(SOFA),the dosage of norepi-nephrine at admission and 6 hours after resuscitation and the utilization rate of mechanical ventilation in group C and group B were signif-icantly higher than those in group A(P<0.05).The platelet levels of patients in group C and group B were significantly lower than those in group A(P<0.05).The 28-day mortality rate in group C was higher than that in group A and group B(P<0.05).Pcv-aCO2/Ca-vO2 6 hours after resuscitation combined with LCR was positively correlated with APACHEII score and SOFA score(P<0.05).Conclusion The combination of Pcv-aCO2/Ca-vO2 and LCR can evaluate the severity and prognosis of sepsis.