medigraphic.com
ISSN 2448-8909 (Print)

2018, Number 2

<< Back Next >>

Med Crit 2018; 32 (2)

Biomarkers of microcirculation versus SOFA scale as predictors of mortality in septic shock

Patiño RMI, Mendoza RM, Huerta VRM, López GA

Language: Spanish
References: 44
Page: 66-75
PDF size: 178.25 Kb.


ABSTRACT

Objective: To demonstrate that the sum of the biomarkers of the microcirculation: CO2 delta, baseline, lactate and central ScVO2 are better predictors of mortality than the SOFA scale in septic shock.
Study method: This study was scheduled to be performed in the ICU of the Hospital of Mexico City in a period from 1 of March 2014 to 1 of July 2017. This is a comparative, ambispective, observational and descriptive. Once these data were obtained, a score was given for each of the biomarkers based on previous studies and a new titration scale was performed where biomarkers were integrated, which was called «microcirculation biomarkers scale» (EBM) and according to the obtained score was assigned a percentage of mortality which was compared with the mortality of the SOFA scale already predetermined for patients with septic shock. The results obtained from these scales were grouped in Pearson correlation graphs as quantitative variables, in the abscissa axis were placed the days of hospital stay and in the axis of the ordinates the obtained score. Subsequently, an association was made with Pearson scales between the scores obtained in the scales with the percentage of mortality of each of the scales, obtaining a linear correlation in the two scales. However, correlation tables between the SOFA and EBM Scale were made The percentage of mortality in a period of 30 days.
Conclusion: It was found that the ability to predict death, which is more significant in the SOFA scale is less sensitive and more specific, however, the EMB scale resulted with a sensitivity of 100% to predict death with a specificity of 76%. Therefore, it is considered a valid scale to determine death in the ICU, however, more studies are required to compare the specificity of this scale.


REFERENCES

  1. Rhodes A, Evans LE, Alhazzani W, Levy MM, Antonelli M, Ferrer R, et al. Surviving sepsis campaign: international guidelines for management of sepsis and septic shock: 2016. Intensive Care Med. 2017;43(3): 304-377.

  2. Cecconi M, Backer DD, Antonelli M, Beale R, Bakker J, Hofer C, et al. Consensus on circulatory shock and hemodynamic monitoring. Task force of the European Society of Intensive Care. Intensive Care Med. 2014;40(12):1795-1815.

  3. Martin GS, Mannino MD, Eaton S, Moss M. The epidemiology of sepsis in the United States from 1979 through 2000. N Engl J Med. 2003;348(16):1546-1554.

  4. Gotts JE, Matthay MA. Sepsis: pathophysiology and clinical management. BMJ. 2016;353:i1585.

  5. De Backer D, Ortiz JA, Salgado D. Coupling microcirculation to systemic hemodynamics. Curr Opin Crit Care. 2010;16(3):250-254.

  6. Drost EM, Kassabian G, Meiselman HJ, Gelmont D, Fisher TC. Increased rigidity and priming of Polymorphonuclear leukocytes in sepsis. Am J Respir Crit Care Med. 1999;159(6):1696-1702.

  7. Deutschman CS, Tracey KJ. Sepsis: current dogma and new perspectives. Immunity. 2014;40(40):463-475.

  8. Lukewicha MK, Rogersb RC, Lomaxc AE. Divergent neuroendocrine responses to localized and systemic inflammation. Semin Immunol. 2014;26(5):402-408.

  9. Lu B, Wang H, Andersson U, Tracey KJ. Regulation of HMGB1 release by inflammasomes. Protein Cell. 2013;4(3):163-167.

  10. O’Neill LA, Golenbock D, Bowie AG. The history of Toll-like receptors redefining innate immunity. Nat Rev Immunol. 2013;13(6):453-460.

  11. Donati A, Domizi R, Damiani E, Adrario E, Pelaia P, Ince C. From macrohemodynamic to the microcirculation. Crit Care Res Pract. 2013;2013:892710.

  12. den Uil CA, Klijn E, Lagrand WK, Brugts JJ, Ince C, Spronk PE, et al. The microcirculation in health and critical disease. Prog Cardiovasc Dis. 2008;51(2):161-170.

  13. Krafft P, Steltw H, Hiesmayr M, Klitnscha W, Hamrnerle AE. Mixed venous oxygen saturation in critically ill septic shock patients the role of defined events. Chest. 1993;103(3):900-906.

  14. Schumacker PT, Cain SM. The concept of a critical oxygen delivery. Intensive Care Med. 1987;13(4):223-229.

  15. Textoris J, Fouché L, Wiramus S, Antonini F, Tho S, Martin C, et al. High central venous oxygen saturation in the latter stages of septic shock is associated with increased mortality. Crit Care. 2011;15(4):R176.

  16. Dellinger RP, Levy MM, Rhodes A, AnnaneA, Gerlach H, Opal SM y cols. Campaña para sobrevivir a la sepsis: recomendaciones internacionales para el tratamiento de sepsis grave y choque septicémico. Intensive Care Med. 2012;41(2):1-58.

  17. Carrillo ER, Núñez BJ, Carrillo CJ. Saturación venosa central. Conceptos actuales. Rev Mex Anest. 2007;30(3):165-171.

  18. Ducrocq N, Kimmoun A, Levy B. Lactate or ScvO2 as an endpoint in resuscitation of shock state? Minerva Anestesiol. 2013;79(9):1049-1058.

  19. Gladden LB. Lactate metabolism: a new paradigm for the third millennium. J Physiol. 2004;558:5-30.

  20. De Backer D, Creteur J, Silva E, Vincent JL. The hepatosplanchnic area is not a common source of lactate in patients with severe sepsis. Crit Care Med. 2001;29(2):256-261.

  21. Levy B. Lactate and shock state: the metabolic view. Curr Opin Crit Care. 2006;12(4):315-321.

  22. Friedman G, De Backer D, Shahla M, Vincent JL. Oxygen supply dependency can characterize septic shock. Intensive Care Med. 1998;24(2):118-123.

  23. Suetrong B, Walley KR. Lactic acidosis in sepsis: it’s not all anaerobic implications for diagnosis and management. Chest. 2016;149(1):252-261.

  24. Ospina-Tascón GA, Bautista-Rincón DF, Umaña M, Tafur JD, Gutiérrez A, García AF, et al. Persistently high venous-to-arterial carbon dioxide differences during early resuscitation are associated with poor outcomes in septic shock. Crit Care. 2013;1(6):R294.

  25. Houwink AP, Rijkenberg S, Bosman RJ, Van der Voort P. The association between lactate, mean arterial pressure, central venous oxygen saturation and peripheral temperature and mortality in severe sepsis: a retrospective cohort analysis. Crit Care. 2016;20:56.

  26. Bakker J, Vincent JL, Gris P, Leon M, Coffernils M, Kahn RJ. Veno-arterial carbon dioxide gradient in human septic shock. Chest. 1992;101(2):509-515.

  27. Valle’e F, Vallet B, Mathe O, Parraguette J, Mari A, Silva S, et al. Central venous-to-arterial carbon dioxide difference: an additional target for goal-directed therapy in septic shock? Intensive Care Med. 2008;34(12):2218-2225.

  28. Zhang H, Vincent JL. Arteriovenous differences in PCO2 and pH are good indicators of critical hypoperfusion. Am Rev Respir Dis. 1993;148(4 Pt 1):867-871.

  29. Mallat J, Lemyze M, Tronchon L, Vallet B, Thevenin D. Use of venous-to-arterial carbon dioxide tension difference to guide resuscitation therapy in septic shock. World J Crit Care Med. 2016;5(1):47-56.

  30. Ocelotl PR, Ramírez JV, De Jesús B, Cortés MJ, Herrera MB, Mendoza MR. Delta de CO2 como factor de riesgo de muerte en choque séptico. Rev Asoc Mex Med Crit y Ter Int. 2016;30(1):30-42.

  31. Wittayachamnankul B, Chentanakij B, Sruamsiri S, Chattipakorn N. The role of central venous oxygen saturation, blood lactate and central venous-to- arterial carbon dioxide partial pressure difference as a goal and prognosis of sepsis treatment. J Crit Care. 2016;36:223-229.

  32. Mesquida J, Borrat X, Lorente JA, Masip J, Baigorri F. Objetivos de la reanimación hemodinámica. Med Intensiva. 2011;35(8):499-508.

  33. Boulain T, Garot P. Vignon J. Lascarrou, Benzekri D, Dequin F. Predicting arterial blood gas and lactate from central venous blood analysis in critically ill patients: a multicentre, prospective, diagnostic accuracy study. Br J Anaesth. 2016;117(3):341-349.

  34. Prasad PA, Shea RE, Shiboski S, Sullivan MC, Gonzales R, Shimabukuro R. Relationship between a sepsis intervention bundle and in-hospital mortality among hospitalized patients: a retrospective analysis of real-world data. Anesth Analg. 2017;125(2):507-513.

  35. The ARISE Investigators and the ANZICS Clinical Trials Group. Goal-directed resuscitation for patients with early septic shock. N Engl J Med. 2014;371:1496-1506.

  36. The ProCESS Investigators. A randomized trial of protocol-based care for early septic shock. N Engl J Med. April 2014; pp. 1-11.

  37. Mouncey PR, Osborn TM, Power GS, Harrison DA, Sadique MZ, Grieve RD, et al. The ProMISe Trial Investigators. Trial of early, goal-directed resuscitation for septic shock. N Engl J Med. 2015;372(14):1301-1311.

  38. Ambroggio L, Florin TA, Shah SS, Ruddy R, Yeomans L, Trexel J, et al. Emerging biomarkers of illness severity: urinary metabolites associated with sepsis and necrotizing methicillin-resistant Staphylococcus aureus pneumonia. Pharmacotherapy. 2017;37(9):1033-1042.

  39. Sakr Y, Dubois MJ, Backer DD, Creteur J, Vincent JL. Persistent microcirculatory alterations are associated with organ failure and death in patients with septic shock. Crit Care Med. 2004;32(9):1825-1831.

  40. Seymour CW, Liu XV, Iwashyna TJ, Brunkhorst FM, Rea TD, Scherag A, et al. Assessment of Clinical Criteria for Sepsis for the Third International Consensus definitions for Sepsis and Septic Shock (Sepsis-3). JAMA. 2016;315(8):762-774.

  41. Vincent JL, Taccone FS. Microvascular monitoring-Do ‘global’ markers help? Best Pract Res Clin Anaesthesiol. 2016;30(4):399-405.

  42. Mutschler M, Nienaber U, Brockamp T, Wafaisade A, Fabian T, Paffrath T, et al. Renaissance of base deficit for the initial assessment of trauma patients: a base deficitbased classification for hypovolemic shock developed on data from 16,305 patients derived from the TraumaRegister DGU. Crit Care. 2013;17(2):R42.

  43. Cuschieri J, Rivers EP, Donnino MW, Katilius M, Jacobsen G, Nguyen HB, et al. Central venous-arterial carbon dioxide difference as an indicator of cardiac index. Intensive Care Med. 2005;31(6):818-822.

  44. Shankar HM, Phillips GS, Levy ML, Seymour CL, Liu VX, Deutschman CS, et al. Developing a new definition and assessing new clinical criteria for septic shock for the third international consensus definitions for sepsis and septic shock (Sepsis-3). JAMA. 2016;315(8):775-787.




2020     |     www.medigraphic.com