- Meeting abstract
Gastric-arterial pCO2 gradient, but not lactate levels, is related to multiple organ dysfunction assessed by SOFA score in septic patients
Critical Care volume 4, Article number: P155 (2000)
The gut hypoperfusion could contribute to development of multiple organ dysfunction in septic patients. However, there is no definitive study correlating the time course of gastric mucosal PCO2 and organ dysfunction.
We have studied prospectively 27 adult severe septic patients consecutively admitted in two large mixed ICUs. Each patient had a nasogastric tonometer and a pulmonary artery catheter. Every 8 h, systemic hemodynamic and oxygen variables, plasma lactate levels and gastric mucosal pCO2 (PgCO2) were measured. All these variables were measured on inclusion day (Day 0) and on the 1st, 2nd and 3rd days. pCO2-gap was calculated as the difference between PgCO2 and PaCO2. Daily, we measured the SOFA score to characterize organ dysfunction evolution. We used the median pCO2-gap and lactate values of each day and time course of these variables to correlate to organ dysfunction and outcome (mortality on day 28). Changes over time were analyzed using a Kruskal-Wallis test and the relative risk (RR) was calculated.
The median age was 55 years and median APACHE II score was 18.5. The overall mortality rate was 52%. Table 1 shows the RR and CI 95% of each variables on day 0, 1, 2 and 3. The best cutoff values of pCO2-gap,lactate values and SOFA score were 15 mmHg, 2 mEq/l and 11, respectively. On the 0, 1st, 2nd and 3rd days, the patients that had pCO2-gap values of more than 14 mmHg, either the SOFA score remained high or the patients died on the 10th day (P<0.05). In contrast, on the same days, lactate levels did not discriminate either organ dysfunction development or death on the 10th day.
There was a good correlation between pCO2-gap and multiple organ dysfunction assessed by SOFA score. Lactate levels were not able to predict outcome.
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Silva, E., Kai, M., Assumpção, M. et al. Gastric-arterial pCO2 gradient, but not lactate levels, is related to multiple organ dysfunction assessed by SOFA score in septic patients. Crit Care 4 (Suppl 1), P155 (2000). https://doi.org/10.1186/cc875