The application of combined central venous pressure and oxygen metabolism parameters monitoring in diagnosing septic shock-induced left ventricular dysfunction / 中华内科杂志
Chinese Journal of Internal Medicine
; (12): 855-859, 2015.
Article
in Zh
| WPRIM
| ID: wpr-483011
Responsible library:
WPRO
ABSTRACT
Objective To evaluate the value of central venous pressure (CVP),central venous oxygen saturation (ScvO2) and venous-arterial carbon dioxide partial pressure gradient (Pv-aCO2) in the diagnosis of septic shock-induced left ventricular dysfunction.Methods Consecutive patients with septic shock were enrolled from September 2013 to September 2014 in ICU at Peking Union Medical College Hospital.The data of CVP,Pv-aCO2 and ScvO2 were recorded and analyzed.According to the left ventricular ejection fraction (LVEF) tested by bedside echocardiography,the patients were divided into two groupsnew onset of left ventricular dysfunction (LVEF < 50%) group and non-left ventricular dysfunction (LVEF ≥ 50%) group.A diagnostic model was created by logistic regression.The diagnostic performance and cut-off values of CVP,Pv-aCO2,ScvO2 were determined using receiver operating characteristic (ROC) curve analysis.Results Among 93 patients enrolled,39 were diagnosed with left ventricular dysfunction.In the new onset group,CVP [(12.5±3.9) mmHg(1 mmHg=0.133 kPa) vs (10.4±2.5)mmHg;P=0.005] and Pv-aCO2 [(7.5 ± 3.9) mmHg vs (4.5 ± 2.6) mmHg;P < 0.001] were significantly higher than those in the non-left ventricular dysfunction group,while ScvO2 [(62.4 ± 10.5) % vs (72.6 ± 9.0) %;P < 0.001] was significantly lower.As far as the diagnostic value of these three parameters were concerned for left ventricular dysfunction,the sensitivity of CVP ≥ 12.5 mmHg was 46.2%,specificity 81.5% with an area under ROC curve (AUCROC) 0.674;the sensitivity of Pv-aCO2 ≥ 5.0 mmHg 76.9%,specificity 37.0%,AUCROC 0.738;the sensitivity of ScvO2 ≤65.8% 64.1%,specificity 78.6%,AUCROC 0.775.When the cut-off values were determined by ROC,the diagnostic performance of the model was ≥0.377 with the sensitivity,specificity and AUCROC 82.1%,79.6% and 0.835,respectively.Conclusion In patients with septic shock,the logistic regression model established by CVP,Pv-aCO2 and ScvO2 contributes to the diagnosis of septic shock-induced left ventricular dysfunction.
Full text:
1
Index:
WPRIM
Type of study:
Diagnostic_studies
/
Prognostic_studies
/
Risk_factors_studies
Language:
Zh
Journal:
Chinese Journal of Internal Medicine
Year:
2015
Type:
Article