Persistence of Central Venous Oxygen Desaturation During Early Sepsis Is Associated With Higher Mortality

• Published in: Chest Vol. 154; no. 6; pp. 1291 - 1300
• Main Authors: Protti, Alessandro, Masson, Serge, Latini, Roberto, Fumagalli, Roberto, Romero, Marilena, Pessina, Carla, Pasetti, Giovanni, Tognoni, Gianni, Pesenti, Antonio, Gattinoni, Luciano, Caironi, Pietro
• Format: Journal Article
• Language: English
• Published: Elsevier Inc 01.12.2018
• Subjects: cardiac dysfunction; early goal-directed therapy; resuscitation; sepsis; SOFA; NT-proBNP; hs-cTnT; SAPS; resuscitation; Scvo2; cardiac dysfunction; sepsis; early goal-directed therapy
• ISSN: 0012-3692; 1931-3543
• DOI: 10.1016/j.chest.2018.04.043

Relevance of low (< 70%) central venous oxygen saturation (Scvo2) during early sepsis has been recently questioned by three negative trials (Protocol-Based Care for Early Septic Shock, Australasian Resuscitation in Sepsis Evaluation, and Protocolized Management in Sepsis) on early goal-directed therapy; however, subjects included in those trials had Scvo2 at enrollment as high as 71 ± 13%, 73 ± 11%, and 70 ± 12%. Here we assess the association between Scvo2 < 70% at 6 h and 90-day mortality in subjects enrolled in the Albumin Italian Outcome Sepsis (ALBIOS) trial, focusing on those with initial Scvo2 < 70%. Regardless of treatment assignment (to receive albumin or not), all subjects enrolled in the ALBIOS trial received early goal-directed therapy aiming for Scvo2 ≥ 70% at 6 h. Using multivariable logistic regression analyses, we tested the association between Scvo2 < 70% at 6 h and 90-day mortality in those with initial Scvo2 < 70% (n = 514) or ≥ 70% (n = 961). Scvo2 < 70% at 6 h was independently associated with higher 90-day mortality in subjects with initial Scvo2 < 70% (OR, 1.84; 95% CI, 1.19-2.85; P = .007) but not in those with initial Scvo2 ≥ 70% (OR, 1.25; 95% CI, 0.79-1.95; P = .357). Scvo2 < 70% at enrollment and at 6 h was associated with history and/or signs of cardiac dysfunction but not with greater severity of disease or more aggressive resuscitation (required per protocol). In the ALBIOS trial, persistence of low Scvo2 was associated with higher 90-day mortality, possibly because it reflected underlying cardiac dysfunction. Subjects with Scvo2 < 70% may benefit most from individually tailored interventions aimed at normalizing the balance between systemic oxygen delivery and consumption. ClinicalTrials.gov; No. NCT00707122; URL: www.clinicaltrials.gov.