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SaO2-SvO2 difference for risk stratification of patients with sepsis and septic shock
Critical Care volume 17, Article number: P55 (2013)
Assessment and monitoring of hemodynamics is a cornerstone in critically ill patients as hemodynamic alteration may become life-threatening in a few minutes [1, 2]. This study aimed to determine whether the SaO2-SvO2 difference could be used as risk stratification for patients with sepsis and septic shock.
Materials and methods
A retrospective cohort study conducted in the ICU of Hospital Santa Luzia, Brasilia, DF, Brazil, during 6 months. An arterial blood sample was collected at admission. Patients with sepsis were divided in two groups: survivors group (SG) and nonsurvivors group (NSG). The accuracy of SaO2-SvO2 difference to predict ICU mortality was measured with the area under the receiver operating characteristic curve.
A total of 131 patients with sepsis were enrolled, 11.5% (n = 15) with septic shock. Age was 66 ± 21 years, SAPS3: 37 ± 17, APACHE II: 14 ± 8, PaO2/FiO2: 342 ± 142 and SaO2/FiO2: 347 ± 109. ICU mortality was 18% (n = 23). The main sites of infections were respiratory (56.5%, n = 74), urinary (19%, n = 25) and cutaneous (7.6%, n = 10). Nonsurvivor patients had higher SaO2-SvO2 difference (26 ± 9 vs. 19 ± 9, P = 0.03). In the group of patients with septic shock, SaO2-SvO2 difference was also higher in nonsurvivors (29 ± 3 vs. 10 ± 2, P = 0.02). All patients with septic shock who died had SaO2-SvO2 difference greater than 25%. The SaO2-SvO2 difference area under ROC curve was 0.714 (95% CI 0.534 to 0.894).
A higher SaO2-SvO2 difference is associated with mortality in patients with sepsis, especially in patients with septic shock.
Gattinoni L, Carlesso E: Supporting hemodynamics: what should we target? What treatments should we use?. Crit Care. 2013, 17: S4-10.1186/cc11502.
Rosário AL, Park M, Brunialti MK, Mendes M, Rapozo M, Fernandes D, Salomão R, Laurindo FR, Schettino GP, Azevedo LC: SvO(2)-guided resuscitation for experimental septic shock: effects of fluid infusion and dobutamine on hemodynamics, inflammatory response, and cardiovascular oxidative stress. Shock. 2011, 36: 604-612. 10.1097/SHK.0b013e3182336aa4.
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Amorim, F.F., Santana, A.R., de Souza, J.L. et al. SaO2-SvO2 difference for risk stratification of patients with sepsis and septic shock. Crit Care 17, P55 (2013). https://doi.org/10.1186/cc12955
- Blood Sample
- Cohort Study
- Septic Shock
- Emergency Medicine
- Risk Stratification