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

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

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

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