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The ∆Pv-aCO(2)/∆Ca-vO(2) ratio as a predictor of mortality in patients with severe acute respiratory distress syndrome related to COVID-19

OBJECTIVE: To evaluate the central venous-to-arterial carbon dioxide difference combined with arterial-to-venous oxygen content difference (∆Pv-aCO2/∆Ca-vO2 ratio) as a predictor of mortality in patients with COVID-19-related severe acute respiratory distress syndrome (ARDS). METHODS: Patients admit...

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Autores principales: Sánchez Díaz, Jesús Salvador, Peniche Moguel, Karla Gabriela, Reyes-Ruiz, José Manuel, Pérez Nieto, Orlando Rubén, Escarramán Martínez, Diego, Zamarrón López, Eder Iván, Calyeca Sánchez, María Verónica
Formato: Online Artículo Texto
Lenguaje:English
Publicado: Public Library of Science 2023
Materias:
Acceso en línea:https://www.ncbi.nlm.nih.gov/pmc/articles/PMC10482256/
https://www.ncbi.nlm.nih.gov/pubmed/37672537
http://dx.doi.org/10.1371/journal.pone.0290272
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author Sánchez Díaz, Jesús Salvador
Peniche Moguel, Karla Gabriela
Reyes-Ruiz, José Manuel
Pérez Nieto, Orlando Rubén
Escarramán Martínez, Diego
Zamarrón López, Eder Iván
Calyeca Sánchez, María Verónica
author_facet Sánchez Díaz, Jesús Salvador
Peniche Moguel, Karla Gabriela
Reyes-Ruiz, José Manuel
Pérez Nieto, Orlando Rubén
Escarramán Martínez, Diego
Zamarrón López, Eder Iván
Calyeca Sánchez, María Verónica
author_sort Sánchez Díaz, Jesús Salvador
collection PubMed
description OBJECTIVE: To evaluate the central venous-to-arterial carbon dioxide difference combined with arterial-to-venous oxygen content difference (∆Pv-aCO2/∆Ca-vO2 ratio) as a predictor of mortality in patients with COVID-19-related severe acute respiratory distress syndrome (ARDS). METHODS: Patients admitted to the intensive care unit with severe ARDS secondary to SARS-CoV-2, and invasive mechanical ventilation were included in this single-center and retrospective cohort study performed between April 18, 2020, and January 18, 2022. The tissue perfusion indexes (lactate, central venous oxygen saturation [ScvO2], and venous-to-arterial carbon dioxide pressure difference [∆Pv-aCO2]), anaerobic metabolism index (∆Pv-aCO2/∆Ca-vO2 ratio), and severity index (Simplified Acute Physiology Score II [SAPSII]) were evaluated to determine its association with the mortality through Cox regression analysis, Kaplan-Meier curve and receiver operating characteristic (ROC) curve. RESULTS: One hundred fifteen patients were included in the study and classified into two groups, the survivor group (n = 54) and the non-survivor group (n = 61). The lactate, ScvO(2), ∆Pv-aCO(2), and ∆Pv-aCO(2)/∆Ca-vO(2) ratio medians were 1.6 mEq/L, 75%, 5 mmHg, and 1.56 mmHg/mL, respectively. The ∆Pv-aCO(2)/∆Ca-vO(2) ratio (Hazard Ratio (HR) = 1.17, 95% confidence interval (CI) = 1.06–1.29, p = 0.001) was identified as a mortality biomarker for patients with COVID-19-related severe ARDS. The area under the curve for ∆Pv-aCO(2)/∆Ca-vO(2) ratio was 0.691 (95% CI 0.598–0.774, p = 0.0001). The best cut-off point for ∆Pv-aCO(2)/∆Ca-vO(2) ratio was >2.14 mmHg/mL, with a sensitivity of 49.18%, specificity of 85.19%, a positive likelihood of 3.32, and a negative likelihood of 0.6. The Kaplan-Meier curve showed that survival rates were significantly worse in patients with values greater than this cut-off point. CONCLUSIONS: The ∆Pv-aCO(2)/∆Ca-vO(2) ratio could be used as a predictor of mortality in patients with severe ARDS secondary to SARS-CoV-2.
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spelling pubmed-104822562023-09-07 The ∆Pv-aCO(2)/∆Ca-vO(2) ratio as a predictor of mortality in patients with severe acute respiratory distress syndrome related to COVID-19 Sánchez Díaz, Jesús Salvador Peniche Moguel, Karla Gabriela Reyes-Ruiz, José Manuel Pérez Nieto, Orlando Rubén Escarramán Martínez, Diego Zamarrón López, Eder Iván Calyeca Sánchez, María Verónica PLoS One Research Article OBJECTIVE: To evaluate the central venous-to-arterial carbon dioxide difference combined with arterial-to-venous oxygen content difference (∆Pv-aCO2/∆Ca-vO2 ratio) as a predictor of mortality in patients with COVID-19-related severe acute respiratory distress syndrome (ARDS). METHODS: Patients admitted to the intensive care unit with severe ARDS secondary to SARS-CoV-2, and invasive mechanical ventilation were included in this single-center and retrospective cohort study performed between April 18, 2020, and January 18, 2022. The tissue perfusion indexes (lactate, central venous oxygen saturation [ScvO2], and venous-to-arterial carbon dioxide pressure difference [∆Pv-aCO2]), anaerobic metabolism index (∆Pv-aCO2/∆Ca-vO2 ratio), and severity index (Simplified Acute Physiology Score II [SAPSII]) were evaluated to determine its association with the mortality through Cox regression analysis, Kaplan-Meier curve and receiver operating characteristic (ROC) curve. RESULTS: One hundred fifteen patients were included in the study and classified into two groups, the survivor group (n = 54) and the non-survivor group (n = 61). The lactate, ScvO(2), ∆Pv-aCO(2), and ∆Pv-aCO(2)/∆Ca-vO(2) ratio medians were 1.6 mEq/L, 75%, 5 mmHg, and 1.56 mmHg/mL, respectively. The ∆Pv-aCO(2)/∆Ca-vO(2) ratio (Hazard Ratio (HR) = 1.17, 95% confidence interval (CI) = 1.06–1.29, p = 0.001) was identified as a mortality biomarker for patients with COVID-19-related severe ARDS. The area under the curve for ∆Pv-aCO(2)/∆Ca-vO(2) ratio was 0.691 (95% CI 0.598–0.774, p = 0.0001). The best cut-off point for ∆Pv-aCO(2)/∆Ca-vO(2) ratio was >2.14 mmHg/mL, with a sensitivity of 49.18%, specificity of 85.19%, a positive likelihood of 3.32, and a negative likelihood of 0.6. The Kaplan-Meier curve showed that survival rates were significantly worse in patients with values greater than this cut-off point. CONCLUSIONS: The ∆Pv-aCO(2)/∆Ca-vO(2) ratio could be used as a predictor of mortality in patients with severe ARDS secondary to SARS-CoV-2. Public Library of Science 2023-09-06 /pmc/articles/PMC10482256/ /pubmed/37672537 http://dx.doi.org/10.1371/journal.pone.0290272 Text en © 2023 Sánchez Díaz et al https://creativecommons.org/licenses/by/4.0/This is an open access article distributed under the terms of the Creative Commons Attribution License (https://creativecommons.org/licenses/by/4.0/) , which permits unrestricted use, distribution, and reproduction in any medium, provided the original author and source are credited.
spellingShingle Research Article
Sánchez Díaz, Jesús Salvador
Peniche Moguel, Karla Gabriela
Reyes-Ruiz, José Manuel
Pérez Nieto, Orlando Rubén
Escarramán Martínez, Diego
Zamarrón López, Eder Iván
Calyeca Sánchez, María Verónica
The ∆Pv-aCO(2)/∆Ca-vO(2) ratio as a predictor of mortality in patients with severe acute respiratory distress syndrome related to COVID-19
title The ∆Pv-aCO(2)/∆Ca-vO(2) ratio as a predictor of mortality in patients with severe acute respiratory distress syndrome related to COVID-19
title_full The ∆Pv-aCO(2)/∆Ca-vO(2) ratio as a predictor of mortality in patients with severe acute respiratory distress syndrome related to COVID-19
title_fullStr The ∆Pv-aCO(2)/∆Ca-vO(2) ratio as a predictor of mortality in patients with severe acute respiratory distress syndrome related to COVID-19
title_full_unstemmed The ∆Pv-aCO(2)/∆Ca-vO(2) ratio as a predictor of mortality in patients with severe acute respiratory distress syndrome related to COVID-19
title_short The ∆Pv-aCO(2)/∆Ca-vO(2) ratio as a predictor of mortality in patients with severe acute respiratory distress syndrome related to COVID-19
title_sort ∆pv-aco(2)/∆ca-vo(2) ratio as a predictor of mortality in patients with severe acute respiratory distress syndrome related to covid-19
topic Research Article
url https://www.ncbi.nlm.nih.gov/pmc/articles/PMC10482256/
https://www.ncbi.nlm.nih.gov/pubmed/37672537
http://dx.doi.org/10.1371/journal.pone.0290272
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