Multicenter study of central venous oxygen saturation (ScvO(2)) as a predictor of mortality in patients with sepsis.
Multicenter study of central venous oxygen saturation (ScvO(2)) as a predictor of mortality in patients with sepsis.
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DOI：
10.1016/j.annemergmed.2009.08.014
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发表时间：
2010-01
影响因子：
6.2
通讯作者：
Shapiro, Nathan I.
中科院分区：
文献类型：
--
作者：
Pope, Jennifer V.;Jones, Alan E.;Gaieski, David F.;Arnold, Ryan C.;Trzeciak, Stephen;Shapiro, Nathan I.
中心静脉血氧饱和度（ScvO 2）异常（低和高）与急诊科（艾德）疑似脓毒症患者的死亡率增加相关。对4家城市三级医院前瞻性收集的接受基于早期目标导向治疗（EGDT）的脓毒症复苏方案治疗的艾德患者登记研究进行二次分析。入选标准：1）脓毒症; 2）低灌注（定义为SBP < 90 mmHg或乳酸≥ 4 mmol/L）; 3）EGDT治疗。ScvO 2水平分为3组：缺氧（ScvO 2 <70%）、常氧（71% - 89%）和高氧（90 - 100%）。主要暴露量为初始ScvO 2和达到的最大Scv 02，主要结局为院内死亡率。进行多变量分析。有619名患者符合标准并被纳入。对于最大ScvO 2，与常氧下的死亡率96/465（21%; 17 - 25%）相比，缺氧死亡率25/62（40%; 29 - 53%）和高氧死亡率31/92（34%; 25 - 44%）均显著较高，在多变量建模中仍具有显著性。当在多变量模型中分析初始ScvO 2测量值时，仅高氧显著更高。在艾德中达到的最大ScvO 2值（异常低和异常高）与死亡率增加相关。在初始ScvO 2的多变量分析中，高氧组与死亡率增加相关，但与缺氧组无关。这项研究表明，未来的研究旨在通过改善微循环流量或线粒体功能障碍的治疗来恢复高ScvO 2值的方法可能是必要的。
Abnormal (both low and high) central venous saturation (ScvO2) is associated with increased mortality in Emergency Department (ED) patients with suspected sepsis. Secondary analysis of four prospectively collected registries of ED patients treated with Early Goal Directed Therapy (EGDT) based sepsis resuscitation protocols from 4 urban tertiary care hospitals. Inclusion criteria: 1) sepsis; 2) hypoperfusion defined by SBP < 90 mmHg or lactate ≥ 4 mmol/L; and 3) EGDT therapy treatment. ScvO2 levels were stratified 3 groups: hypoxia (ScvO2 <70%); normoxia (71% - 89%); and hyperoxia (90 – 100%). The primary exposures were initial ScvO2 and maximum Scv02 achieved with the primary outcome as in-hospital mortality. Multivariate analysis was performed. There were 619 patients who met criteria and were included. For the maximum ScvO2, compared to the mortality rate in the normoxia of 96/465 (21%; 17 – 25%), both the hypoxia mortality rate 25/62 (40%; 29 – 53%) and hyperoxia mortality rate 31/92 (34%; 25 – 44%) were significantly higher, which remained significant in a multivariate modeling. When the initial ScvO2 measurement was analyzed in a multivariate model, only hyperoxia was significantly higher. The maximum ScvO2 value achieved in the ED (both abnormally low and high) was associated with increased mortality. In multivariate analysis for initial ScvO2, the hyperoxia group was associated with increased mortality, but not the hypoxia group. This study suggests that future research aimed to target methods to normalize high ScvO2 values via therapies that improve microcirculatory flow or mitochondrial dysfunction may be warranted.
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影响因子：
158.5
作者：
Rivers, E;Nguyen, B;Tomlanovich, M
通讯作者：
Tomlanovich, M
影响因子：
3.3
作者：
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影响因子：
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作者：
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影响因子：
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作者：
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通讯作者：
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影响因子：
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作者：
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通讯作者：
Hollenberg, Steven M.