Prognostic Value and Agreement of Achieving Lactate Clearance or Central Venous Oxygen Saturation Goals During Early Sepsis Resuscitation

Academic Emergency Medicine, 04/17/2012

Puskarich MA et al. – No agreement was found between Lactate clearance (LC) and central venous oxygen saturation (ScvO2) goal achievement in early sepsis resuscitation. Achievement of a ScvO2≥70% without LC≥10% was more strongly associated with mortality than achievement of LC≥10% with failure to achieve ScvO2≥70%.

Methods

  • This was a preplanned analysis of a multicenter ED randomized controlled trial of early sepsis resuscitation targeting three variables: central venous pressure, mean arterial pressure, and either ScvO2 or LC.
  • Inclusion criteria included suspected infection, two or more systemic inflammation criteria, and either systolic blood pressure of <90mmHg after intravenous fluid bolus or lactate level of >4mmol/L.
  • Both ScvO2 and LC were measured simultaneously.
  • The ScvO2 goal was defined as ≥70%.
  • Lactate was measured at enrollment and every 2hours until the goal was reached or up to 6hours.
  • LC goal was defined as a decrease of ≥10% from initial measurement.
  • The primary outcome was in-hospital mortality.

Results

  • A total of 203 subjects were included, with an overall mortality of 19.7%.
  • Achievement of the ScvO2 goal only was associated with a mortality rate of 41% (9/22), while achievement of the LC goal only was associated with a mortality rate of 8% (2/25; proportion difference=33%; 95% confidence interval [CI]=9% to 55%).
  • No agreement was found between goal achievement (κ=-0.02), and exact test for matched pairs demonstrated no significant difference between discordant pairs (p=0.78).

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