Multicenter Study of Central Venous Oxygen Saturation (ScvO2 ) as a Predictor of Mortality in Patients With Sepsis

• Published in: Annals of emergency medicine Vol. 55; no. 1; pp. 40 - 46.e1
• Main Authors: Pope, Jennifer V., MD, Jones, Alan E., MD, Gaieski, David F., MD, Arnold, Ryan C., MD, Trzeciak, Stephen, MD, MPH, Shapiro, Nathan I., MD, MPH
• Format: Journal Article
• Language: English
• Published: New York, NY Mosby, Inc 01-01-2010; Elsevier
• Subjects: Aged; Anesthesia. Intensive care medicine. Transfusions. Cell therapy and gene therapy; Biological and medical sciences; Blood and lymphatic vessels; Cardiology. Vascular system; Diseases of the peripheral vessels. Diseases of the vena cava. Miscellaneous; Emergency; Female; Hospital Mortality; Humans; Hyperoxia - blood; Hyperoxia - etiology; Hyperoxia - mortality; Hypoxia - blood; Hypoxia - etiology; Hypoxia - mortality; Intensive care medicine; Male; Medical sciences; Middle Aged; Multivariate Analysis; Oxygen - blood; Prognosis; Shock, Septic - blood; Shock, Septic - complications; Shock, Septic - mortality; United States - epidemiology; Human; Infection; Sepsis syndrome; Oxygen; Intensive care; Multicenter study; Mortality; Saturation; Resuscitation
• ISSN: 0196-0644; 1097-6760
• DOI: 10.1016/j.annemergmed.2009.08.014

Study objective Abnormal (both low and high) central venous saturation (ScvO2 ) is associated with increased mortality in emergency department (ED) patients with suspected sepsis. Methods This was a secondary analysis of 4 prospectively collected registries of ED patients treated with early goal-directed therapy–based sepsis resuscitation protocols from 4 urban tertiary care hospitals. Inclusion criteria were sepsis, hypoperfusion defined by systolic blood pressure less than 90 mm Hg or lactate level greater than or equal to 4 mmol/L, and early goal-directed therapy treatment. ScvO2 levels were stratified into 3 groups: hypoxia (ScvO2 <70%); normoxia (ScvO2 71% to 89%); and hyperoxia (ScvO2 90% to 100%). The primary exposures were initial ScvO2 and maximum ScvO2 achieved, with the primary outcome as inhospital mortality. Multivariate analysis was performed. Results There were 619 patients who met criteria and were included. For the maximum ScvO2 , compared with the mortality rate in the normoxia group of 96 of 465 (21%; 95% confidence interval [CI] 17% to 25%), both the hypoxia mortality rate, 25 of 62 (40%; 95% CI 29% to 53%) and hyperoxia mortality rate, 31 of 92 (34%; 95% CI 25% to 44%) were significantly higher, which remained significant in a multivariate modeling. When the initial ScvO2 measurement was analyzed in a multivariate model, only hyperoxia was significantly higher. Conclusion The maximum ScvO2 value achieved in the ED (both abnormally low and high) was associated with increased mortality. In multivariate analysis for initial ScvO2 , the hyperoxia group was associated with increased mortality, but not the hypoxia group. This study suggests that future research aimed at targeting methods to normalize high ScvO2 values by therapies that improve microcirculatory flow or mitochondrial dysfunction may be warranted.