Increased admission central venous-arterial CO2 difference predicts ICU-mortality in adult cardiac surgery patients

TY - JOUR

T1 - Increased admission central venous-arterial CO2 difference predicts ICU-mortality in adult cardiac surgery patients

AU - Zante, Bjoern

AU - Reichenspurner, Hermann

AU - Kubik, Mathias

AU - Schefold, Joerg C

AU - Kluge, Stefan

N1 - Copyright © 2019 Elsevier Inc. All rights reserved.

PY - 2019/6/16

Y1 - 2019/6/16

N2 - BACKGROUND: Invasive procedures such as cardiac surgery are associated with perioperative dysfunction of macrocirculation and/or microcirculation and organ failures. Maintenance or resuscitation of an adequate macrocirculation and/or microcirculation is thus crucial in patients after cardiac surgery. We investigated the prognostic power of early central venous-arterial carbon dioxide pressure difference (delta-pCO2) after cardiac surgery.METHODS: Retrospective analysis of data from 1,019 cardiac surgery patients treated in the ICU of a tertiary medical care academic center. Clinical outcomes and laboratory measures including metabolic indices and calculated delta-pCO2 were assessed. Receiver operating characteristic (ROC) curves were generated and sensitivity / specificity analysis was performed. Univariate and multivariate regression models were analyzed.RESULTS: The area under the ROC curve for delta-pCO2 to predict ICU mortality was 0.72 (sensitivity 65% / specificity 76%) with an optimal delta-pCO2 cut-off value of 8.6 mmHg. In multivariate regression, delta-pCO2 was associated with increased ICU mortality (HR 3.72, 95%-CI 1.3-10.66, p = 0.02). After adjustment for typical confounders, delta-pCO2 remained as independent predictor of ICU mortality after cardiac surgery.CONCLUSIONS: In a retrospective data analysis in a large sample of adult post cardiac surgery patients treated in the ICU, we observed that admission central venous-arterial delta-pCO2 independently predicts ICU mortality. Delta-pCO2 might thus contribute risk stratification in ICU patients after cardiac surgery.

AB - BACKGROUND: Invasive procedures such as cardiac surgery are associated with perioperative dysfunction of macrocirculation and/or microcirculation and organ failures. Maintenance or resuscitation of an adequate macrocirculation and/or microcirculation is thus crucial in patients after cardiac surgery. We investigated the prognostic power of early central venous-arterial carbon dioxide pressure difference (delta-pCO2) after cardiac surgery.METHODS: Retrospective analysis of data from 1,019 cardiac surgery patients treated in the ICU of a tertiary medical care academic center. Clinical outcomes and laboratory measures including metabolic indices and calculated delta-pCO2 were assessed. Receiver operating characteristic (ROC) curves were generated and sensitivity / specificity analysis was performed. Univariate and multivariate regression models were analyzed.RESULTS: The area under the ROC curve for delta-pCO2 to predict ICU mortality was 0.72 (sensitivity 65% / specificity 76%) with an optimal delta-pCO2 cut-off value of 8.6 mmHg. In multivariate regression, delta-pCO2 was associated with increased ICU mortality (HR 3.72, 95%-CI 1.3-10.66, p = 0.02). After adjustment for typical confounders, delta-pCO2 remained as independent predictor of ICU mortality after cardiac surgery.CONCLUSIONS: In a retrospective data analysis in a large sample of adult post cardiac surgery patients treated in the ICU, we observed that admission central venous-arterial delta-pCO2 independently predicts ICU mortality. Delta-pCO2 might thus contribute risk stratification in ICU patients after cardiac surgery.

U2 - 10.1016/j.hrtlng.2019.05.015

DO - 10.1016/j.hrtlng.2019.05.015

M3 - SCORING: Journal article

C2 - 31200923

VL - 48

SP - 421

EP - 427

IS - 5

ER -