Comparison of the venous-arterial CO2 to arterial-venous O2 content difference ratio with the venous-arterial CO2 gradient for the predictability of adverse outcomes after cardiac surgery
Comparison of the venous-arterial CO2 to arterial-venous O2 content difference ratio with the venous-arterial CO2 gradient for the predictability of adverse outcomes after cardiac surgery
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DOI：
10.1007/s10877-019-00286-z
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发表时间：
2020-02-01
影响因子：
2.2
通讯作者：
Nishikawa, Kiyonobu
中科院分区：
文献类型：
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作者：
Mukai, Akira;Suehiro, Koichi;Nishikawa, Kiyonobu
本研究旨在比较混合和中心静脉-动脉CO2张力差与动脉-静脉O-2含量差的比值（分别为Pv-aCO（2）/Ca-vO（2）和Pcv-aCO（2）/Ca-cvO（2））与混合和中心静脉-动脉二氧化碳梯度（分别为Pv-aCO（2）和Pcv-aCO（2））对心脏手术后不良事件的预后性能。入组了110例接受体外循环心脏手术的患者。导管插入后，通过动脉压，中心静脉和肺动脉导管同时抽取三个血液样本，术前和手术结束时，并确定术前和术后值。主要终点设定为术后主要器官发病率和死亡率（MOMM）。采用受试者工作特征（ROC）曲线和多因素Logistic回归分析评价Pv-aCO（2）、Pcv-aCO（2）、Pv-aCO（2）/Ca-vO（2）和Pcv-aCO（2）/Ca-cvO（2）对MOMM的预后可靠性。25例患者（22.7%）发生MOMM事件。ROC曲线分析显示术后Pv-aCO（2）/Ca-vO（2）和Pcv-aCO（2）/Ca-cvO（2）均为MOMM的显著预测因素。然而，术后Pv-aCO（2）是MOMM的最佳预测因子（曲线下面积[AUC]：0.804; 95%置信区间[CI] 0.688-0.921），在5.1 mmHg临界值时，灵敏度为76.0%，特异性为74.1%。多变量分析显示，术后Pv-aCO（2）是MOMM（比值比[OR]：1.42，95% CI 1.01-2.00，p = 0.046）和ICU住院时间延长（OR：1.45，95% CI 1.05-2.01，p = 0.024）的独立预测因子。心脏手术结束时Pv-aCO（2）比Pv-aCO（2）/Ca-vO（2）和Pcv-aCO（2）/Ca-cvO（2）更能预测术后并发症。
This study aimed to compare the prognostic performance of the ratio of mixed and central venous-arterial CO2 tension difference to arterial-venous O-2 content difference (Pv-aCO(2)/Ca-vO(2) and Pcv-aCO(2)/Ca-cvO(2), respectively) with that of the mixed and central venous-to-arterial carbon dioxide gradient (Pv-aCO(2) and Pcv-aCO(2), respectively) for adverse events after cardiac surgery. One hundred and ten patients undergoing cardiac surgery with cardiopulmonary bypass were enrolled. After catheter insertion, three blood samples were withdrawn simultaneously through arterial pressure, central venous, and pulmonary artery catheters, before and at the end of the operation, and preoperative and postoperative values were determined. The primary end-point was set as the incidence of postoperative major organ morbidity and mortality (MOMM). Receiver operating characteristic (ROC) curve and multivariate logistic regression analyses were performed to evaluate the prognostic reliability of Pv-aCO(2), Pcv-aCO(2), Pv-aCO(2)/Ca-vO(2), and Pcv-aCO(2)/Ca-cvO(2) for MOMM. MOMM events occurred in 25 patients (22.7%). ROC curve analysis revealed that both postoperative Pv-aCO(2)/Ca-vO(2) and Pcv-aCO(2)/Ca-cvO(2) were significant predictors of MOMM. However, postoperative Pv-aCO(2) was the best predictor of MOMM (area under the curve [AUC]: 0.804; 95% confidence interval [CI] 0.688-0.921), at a 5.1-mmHg cut-off, sensitivity was 76.0%, and specificity was 74.1%. Multivariate analysis revealed that postoperative Pv-aCO(2) was an independent predictor of MOMM (odds ratio [OR]: 1.42, 95% CI 1.01-2.00, p = 0.046) and prolonged ICU stay (OR: 1.45, 95% CI 1.05-2.01, p = 0.024). Pv-aCO(2) at the end of cardiac surgery was a better predictor of postoperative complications than Pv-aCO(2)/Ca-vO(2) and Pcv-aCO(2)/Ca-cvO(2).