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Master Thesis

Différence veinoartérielle en dioxyde de carbone (P(v-a)CO2) : facteur prédictif du pronostic des patients septiques variant en fonction de la Scv02

Abstract : Background: Venous-to-arterial carbon dioxide difference (cv-art CO₂ gap) is a marker of tissue perfusion. Despite being in the security zone, high central venous oxygen saturation (ScvO₂) is associated with poor outcome in patients with septic shock. The aim of this study is to assess the ability of the cv-art CO₂ gap to predict clinical worsening in patients with septic shock, according to ScvO₂. Methods: We performed a multicentric prospective study in 3 ICUs. All consecutive patients with septic shock were included during the study period. Patients were assigned into three groups according to ScvO₂. Clinical worsening was defined as an increase of SOFA score ≥ 1 two days after admission (Δ SOFA ≥ 1). Patients characteristics and severity scores were collected during the first three days of stay. To assess the ability of the cv-art CO₂ gap to predict a clinical worsening, a ROC curve was produced for the event Δ SOFA ≥ 1. Associations between cv-art CO₂ gap and 28-day mortality along with length-of-stay (LOS) were explored using linear regression and correlations. Results: Fifty-six patients were included. 28-day mortality was 23% with an admission mean SOFA score of 9 ± 3. On admission, mean ScvO₂, blood lactate and cv-art CO₂ gap were 74 ± 13%, 3.4 ± 2.8 mmol/l and 6 ± 4.5 mmHg, respectively. Considering all patients, cv-art CO₂ gap failed to predict a Δ SOFA ≥ 1 (AUC=0.57). However, a threshold of cv-art CO₂ gap ≥ 5.7 in the [70-80%] ScvO₂ group could predict clinical worsening (Se=67%, Sp=75%, PPV=57%, NPV=82%, AUC=0.7). In addition, every increase of 1 mmHg in cv-art CO₂ gap might extend the LOS by 1.8 day (95% CI [0.2 - 3.4], p = 0.025). Finally, 28-day mortality of patients with mean cv-art CO₂ gap> 6 mmHg within 72 hours was 39% compared with 16% for patients with cv-art CO₂ gap ≤ 6 mmHg (p = 0.056). Conclusion: cv-art CO₂ gap is a reliable parameter to assess the inadequacy of circulating blood flow in response to metabolic demand. cv-art CO₂ gap could help clinicians to identify septic shock patients with organ dysfunction despite normalization of ScvO₂.
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https://dumas.ccsd.cnrs.fr/dumas-01886976
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Submitted on : Wednesday, October 3, 2018 - 2:25:21 PM
Last modification on : Monday, July 6, 2020 - 4:46:58 PM
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Romain Ronfle. Différence veinoartérielle en dioxyde de carbone (P(v-a)CO2) : facteur prédictif du pronostic des patients septiques variant en fonction de la Scv02. Sciences du Vivant [q-bio]. 2017. ⟨dumas-01886976⟩

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