Persistence of central venous oxygen desaturation during early sepsis is associated with higher mortality: a retrospective analysis of the ALBIOS trial.
Chest. 2018 May 19;:
Authors: Protti A, Masson S, Latini R, Fumagalli R, Romero M, Pessina C, Pasetti G, Tognoni G, Pesenti A, Gattinoni L, Caironi P
Abstract
BACKGROUND: Relevance of low (<70%) central venous oxygen saturation (ScvO2) during early sepsis has been recently questioned by three negative trials (ProCESS, ARISE and ProMISe) on early goal-directed therapy (EGDT). However, subjects included in those trials had ScvO2 at enrolment as high as 71±13%, 73±11% and 70±12%. Herein we assessed the association between ScvO2 <70% at six hours and 90-day mortality in subjects enrolled in the ALBIOS trial, focusing on those with initial ScvO2 <70%.
METHODS: Irrespectively from treatment assignment (to receive albumin or not), all subjects enrolled in the ALBIOS trial received EGDT aiming for ScvO2 ≥70% at six hours. Using multivariable logistic regression analyses, we tested the association between ScvO2 <70% at six hours and 90-day mortality in those with initial ScvO2 <70% (n=514) or ≥70% (n=961).
RESULTS: ScvO2 <70% at six hours was independently associated with higher 90-day mortality in subjects with initial ScvO2 <70% (OR 1·84, 95%-CI 1·19-2·85; p=0·007) but not in those with initial ScvO2 ≥70% (OR 1·25, 95%-CI 0·79-1·95; p=0·357). ScvO2 <70% at study enrolment and at six hours was associated with history and/or signs of cardiac dysfunction but not with greater severity of disease or more aggressive resuscitation (required per protocol).
CONCLUSIONS: In the ALBIOS trial, persistence of low ScvO2 was associated with higher 90-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.
TRIAL REGISTRY: ClinicalTrials.gov; NCT00707122.
PMID: 29787743 [PubMed - as supplied by publisher]