Persistence of Central Venous Oxygen Desaturation During Early Sepsis Is Associated With Higher Mortality: A Retrospective Analysis of the ALBIOS Trial

Alessandro Protti, Serge Masson, Roberto Latini, Roberto Fumagalli, Marilena Romero, Carla Pessina, Giovanni Pasetti, Gianni Tognoni, Antonio Pesenti, Luciano Gattinoni, Pietro Caironi

Research output: Contribution to journalArticle

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Abstract

Background: Relevance of low (< 70%) central venous oxygen saturation (ScvO2) during early sepsis has been recently questioned by three negative trials (Protocol-Based Care for Early Septic Shock, Australasian Resuscitation in Sepsis Evaluation, and Protocolized Management in Sepsis) on early goal-directed therapy; however, subjects included in those trials had ScvO2 at enrollment as high as 71 ± 13%, 73 ± 11%, and 70 ± 12%. Here we assess the association between ScvO2 < 70% at 6 h and 90-day mortality in subjects enrolled in the Albumin Italian Outcome Sepsis (ALBIOS) trial, focusing on those with initial ScvO2 < 70%. Methods: Regardless of treatment assignment (to receive albumin or not), all subjects enrolled in the ALBIOS trial received early goal-directed therapy aiming for ScvO2 ≥ 70% at 6 h. Using multivariable logistic regression analyses, we tested the association between ScvO2 < 70% at 6 h and 90-day mortality in those with initial ScvO2 < 70% (n = 514) or ≥ 70% (n = 961). Results: ScvO2 < 70% at 6 h was independently associated with higher 90-day mortality in subjects with initial ScvO2 < 70% (OR, 1.84; 95% CI, 1.19-2.85; P =.007) but not in those with initial ScvO2 ≥ 70% (OR, 1.25; 95% CI, 0.79-1.95; P =.357). ScvO2 < 70% at enrollment and at 6 h was associated with history and/or signs of cardiac dysfunction but not with greater severity of disease or more aggressive resuscitation (required per protocol). Conclusions: In the ALBIOS trial, persistence of low ScvO2 was associated with higher 90-day mortality, possibly because it reflected underlying cardiac dysfunction. Subjects with ScvO2 < 70% may benefit most from individually tailored interventions aimed at normalizing the balance between systemic oxygen delivery and consumption. Trial Registry: ClinicalTrials.gov; No. NCT00707122; URL: www.clinicaltrials.gov.

Original languageEnglish
Pages (from-to)1291-1300
JournalChest
Volume154
Issue number6
DOIs
Publication statusPublished - 2018

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Albumins
Sepsis
Oxygen
Mortality
Resuscitation
Clinical Protocols
Septic Shock
Oxygen Consumption
Registries
Therapeutics
Logistic Models
History
Regression Analysis

Keywords

  • cardiac dysfunction
  • early goal-directed therapy
  • resuscitation
  • sepsis

ASJC Scopus subject areas

  • Pulmonary and Respiratory Medicine
  • Critical Care and Intensive Care Medicine
  • Cardiology and Cardiovascular Medicine

Cite this

Persistence of Central Venous Oxygen Desaturation During Early Sepsis Is Associated With Higher Mortality : A Retrospective Analysis of the ALBIOS Trial. / Protti, Alessandro; Masson, Serge; Latini, Roberto; Fumagalli, Roberto; Romero, Marilena; Pessina, Carla; Pasetti, Giovanni; Tognoni, Gianni; Pesenti, Antonio; Gattinoni, Luciano; Caironi, Pietro.

In: Chest, Vol. 154, No. 6, 2018, p. 1291-1300.

Research output: Contribution to journalArticle

Protti, Alessandro ; Masson, Serge ; Latini, Roberto ; Fumagalli, Roberto ; Romero, Marilena ; Pessina, Carla ; Pasetti, Giovanni ; Tognoni, Gianni ; Pesenti, Antonio ; Gattinoni, Luciano ; Caironi, Pietro. / Persistence of Central Venous Oxygen Desaturation During Early Sepsis Is Associated With Higher Mortality : A Retrospective Analysis of the ALBIOS Trial. In: Chest. 2018 ; Vol. 154, No. 6. pp. 1291-1300.
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title = "Persistence of Central Venous Oxygen Desaturation During Early Sepsis Is Associated With Higher Mortality: A Retrospective Analysis of the ALBIOS Trial",
abstract = "Background: Relevance of low (< 70{\%}) central venous oxygen saturation (ScvO2) during early sepsis has been recently questioned by three negative trials (Protocol-Based Care for Early Septic Shock, Australasian Resuscitation in Sepsis Evaluation, and Protocolized Management in Sepsis) on early goal-directed therapy; however, subjects included in those trials had ScvO2 at enrollment as high as 71 ± 13{\%}, 73 ± 11{\%}, and 70 ± 12{\%}. Here we assess the association between ScvO2 < 70{\%} at 6 h and 90-day mortality in subjects enrolled in the Albumin Italian Outcome Sepsis (ALBIOS) trial, focusing on those with initial ScvO2 < 70{\%}. Methods: Regardless of treatment assignment (to receive albumin or not), all subjects enrolled in the ALBIOS trial received early goal-directed therapy aiming for ScvO2 ≥ 70{\%} at 6 h. Using multivariable logistic regression analyses, we tested the association between ScvO2 < 70{\%} at 6 h and 90-day mortality in those with initial ScvO2 < 70{\%} (n = 514) or ≥ 70{\%} (n = 961). Results: ScvO2 < 70{\%} at 6 h was independently associated with higher 90-day mortality in subjects with initial ScvO2 < 70{\%} (OR, 1.84; 95{\%} CI, 1.19-2.85; P =.007) but not in those with initial ScvO2 ≥ 70{\%} (OR, 1.25; 95{\%} CI, 0.79-1.95; P =.357). ScvO2 < 70{\%} at enrollment and at 6 h was associated with history and/or signs of cardiac dysfunction but not with greater severity of disease or more aggressive resuscitation (required per protocol). Conclusions: In the ALBIOS trial, persistence of low ScvO2 was associated with higher 90-day mortality, possibly because it reflected underlying cardiac dysfunction. Subjects with ScvO2 < 70{\%} may benefit most from individually tailored interventions aimed at normalizing the balance between systemic oxygen delivery and consumption. Trial Registry: ClinicalTrials.gov; No. NCT00707122; URL: www.clinicaltrials.gov.",
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T1 - Persistence of Central Venous Oxygen Desaturation During Early Sepsis Is Associated With Higher Mortality

T2 - A Retrospective Analysis of the ALBIOS Trial

AU - Protti, Alessandro

AU - Masson, Serge

AU - Latini, Roberto

AU - Fumagalli, Roberto

AU - Romero, Marilena

AU - Pessina, Carla

AU - Pasetti, Giovanni

AU - Tognoni, Gianni

AU - Pesenti, Antonio

AU - Gattinoni, Luciano

AU - Caironi, Pietro

PY - 2018

Y1 - 2018

N2 - Background: Relevance of low (< 70%) central venous oxygen saturation (ScvO2) during early sepsis has been recently questioned by three negative trials (Protocol-Based Care for Early Septic Shock, Australasian Resuscitation in Sepsis Evaluation, and Protocolized Management in Sepsis) on early goal-directed therapy; however, subjects included in those trials had ScvO2 at enrollment as high as 71 ± 13%, 73 ± 11%, and 70 ± 12%. Here we assess the association between ScvO2 < 70% at 6 h and 90-day mortality in subjects enrolled in the Albumin Italian Outcome Sepsis (ALBIOS) trial, focusing on those with initial ScvO2 < 70%. Methods: Regardless of treatment assignment (to receive albumin or not), all subjects enrolled in the ALBIOS trial received early goal-directed therapy aiming for ScvO2 ≥ 70% at 6 h. Using multivariable logistic regression analyses, we tested the association between ScvO2 < 70% at 6 h and 90-day mortality in those with initial ScvO2 < 70% (n = 514) or ≥ 70% (n = 961). Results: ScvO2 < 70% at 6 h was independently associated with higher 90-day mortality in subjects with initial ScvO2 < 70% (OR, 1.84; 95% CI, 1.19-2.85; P =.007) but not in those with initial ScvO2 ≥ 70% (OR, 1.25; 95% CI, 0.79-1.95; P =.357). ScvO2 < 70% at enrollment and at 6 h was associated with history and/or signs of cardiac dysfunction but not with greater severity of disease or more aggressive resuscitation (required per protocol). Conclusions: In the ALBIOS trial, persistence of low ScvO2 was associated with higher 90-day mortality, possibly because it reflected underlying cardiac dysfunction. Subjects with ScvO2 < 70% may benefit most from individually tailored interventions aimed at normalizing the balance between systemic oxygen delivery and consumption. Trial Registry: ClinicalTrials.gov; No. NCT00707122; URL: www.clinicaltrials.gov.

AB - Background: Relevance of low (< 70%) central venous oxygen saturation (ScvO2) during early sepsis has been recently questioned by three negative trials (Protocol-Based Care for Early Septic Shock, Australasian Resuscitation in Sepsis Evaluation, and Protocolized Management in Sepsis) on early goal-directed therapy; however, subjects included in those trials had ScvO2 at enrollment as high as 71 ± 13%, 73 ± 11%, and 70 ± 12%. Here we assess the association between ScvO2 < 70% at 6 h and 90-day mortality in subjects enrolled in the Albumin Italian Outcome Sepsis (ALBIOS) trial, focusing on those with initial ScvO2 < 70%. Methods: Regardless of treatment assignment (to receive albumin or not), all subjects enrolled in the ALBIOS trial received early goal-directed therapy aiming for ScvO2 ≥ 70% at 6 h. Using multivariable logistic regression analyses, we tested the association between ScvO2 < 70% at 6 h and 90-day mortality in those with initial ScvO2 < 70% (n = 514) or ≥ 70% (n = 961). Results: ScvO2 < 70% at 6 h was independently associated with higher 90-day mortality in subjects with initial ScvO2 < 70% (OR, 1.84; 95% CI, 1.19-2.85; P =.007) but not in those with initial ScvO2 ≥ 70% (OR, 1.25; 95% CI, 0.79-1.95; P =.357). ScvO2 < 70% at enrollment and at 6 h was associated with history and/or signs of cardiac dysfunction but not with greater severity of disease or more aggressive resuscitation (required per protocol). Conclusions: In the ALBIOS trial, persistence of low ScvO2 was associated with higher 90-day mortality, possibly because it reflected underlying cardiac dysfunction. Subjects with ScvO2 < 70% may benefit most from individually tailored interventions aimed at normalizing the balance between systemic oxygen delivery and consumption. Trial Registry: ClinicalTrials.gov; No. NCT00707122; URL: www.clinicaltrials.gov.

KW - cardiac dysfunction

KW - early goal-directed therapy

KW - resuscitation

KW - sepsis

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