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The Predictive Ability of PV-ACO2 Gap and PV-ACO2/CA-VO2 Ratio in Shock: A Prospective, Cohort Study
Mohammad Shaban1, Nawal Salahuddin, Mohammad Raed Kolko
1Department of Adult Critical Care Medicine, King Faisal Specialist Hospital and Research Centre, Riyadh, Saudi Arabia Department of Respiratory Care Services, King Faisal Specialist Hospital and Research Centre, Riyadh, Saudi Arabia.
Introduction:
Compromised tissue oxygenation leads to anaerobiosis, leading to organ failure and death. This study attempts to demonstrate the predictive abilities of the Pv-aCO2 gap and Pv-aCO2/Ca-vO2 ratio in shock patients undergoing resuscitation.
Methods:
In a prospective study, consecutive patients with shock were included. Timed measurements of Pv-aCO2 gap, ScvO2, lactate, and Pv-aCO2/ Ca-vO2 ratio were obtained. The association between the mortality and each variable at all intervals was analyzed. Receiver operating characteristics curves were built.
Results:
Fifty patients were enrolled. Intensive care unit survivors had a higher Pv-aCO2/ Ca-vO2 ratio at time 0 (0.21, interquartile range [IQR] 0.14 vs. 0.27, IQR 0.38, P = 0.032) and at 3 h (0.27, IQR 0.08 vs. 0.21, IQR 0.12, P = 0.035).Twenty-eight day survival was higher in patients with a low Pv-aCO2 gap at time 0 (7.5, IQR 7 vs. 4.8, IQR 5, P = 0.007).Baseline Pv-aCO2 gap and Pv-aCO2/Ca-vO2 ratio showed good ability to predict 28-day mortality as seen by AUC 0.728 (95% CI 0.578-0.877, P = 0.007) and 0.711 (95% CI 0.563-0.860, P = 0.013). A cut-off point of Pv-aCO2 gap ≥6 mm Hg identified 28-day mortality (75% vs. 45.5%, P = 0.034). The best cutoff values, at baseline, to predict 28-day mortality were 0.25 for the Pv-aCO2/Ca-vO2 ratio (sensitivity 58%, specificity 85%, LR+ 3.86, LR- 0.49) and 6.3 for the Pv-aCO2 gap (sensitivity 58%, specificity 79%, LR+ 2.76, LR- 0.53).
Conclusion:
This study suggests that Pv-aCO2 gap and Pv-aCO2/Ca-vO2 ratio are discriminating predictors of 28-day mortality and can be used to provide supplementary information during resuscitation in shock.
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