TY - JOUR

T1 - Association Between the Oxygen Consumption:

T2 - Lactate Ratio and Survival in Critically Ill Patients With Sepsis

AU - Hoeyer-Nielsen, Anne Kirstine

AU - Holmberg, Mathias J.

AU - Grossestreuer, Anne V.

AU - Yankama, Tuyen

AU - Branton, Jean-Pierre

AU - Donnino, Michael W.

AU - Berg, Katherine M.

PY - 2021/6

Y1 - 2021/6

N2 - INTRODUCTION: Mitochondrial dysfunction leading to impairment of oxygen extraction, referred to as cytopathic hypoxia, contributes to morbidity in sepsis. Oxygen consumption (VO2) may be a useful measure of the severity of cytopathic hypoxia. We monitored VO2 and carbon dioxide production (VCO2) in septic patients and investigated the association with hospital survival. METHODS: We retrospectively identified adult (≥18 years) septic patients from a larger prospective observational cohort of critically ill patients on mechanical ventilation. A gas-exchange monitor recorded continuous VO2 and VCO2 for up to 48 hours. We then tested the association of median VO2, VCO2, respiratory quotient (RQ) and the VO2: lactate ratio with survival. RESULTS: A total of 46 septic patients were included in the analysis, of whom 28 (61%) survived. Overall median VO2 was not associated with survival (3.72 mL/kg/min [IQR: 3.39, 4.92] in survivors and 3.42 mL/kg/min [IQR: 2.97, 5.26] in non-survivors, p = 0.12). The overall median VCO2 and RQ were also not associated with survival. Adjusting for age and the presence of shock did not change these results. The VO2: lactate ratio was associated with survival (adjusted OR 2.17 [95% CI 1.12, 4.22] per unit increase in ratio, p = 0.03). The percent change in median VCO2 was 11.6% [IQR: -8.2, 28.7] in survivors compared to -8.3% [IQR: -18.0, 4.7] in non-survivors (p = 0.03). The percent changes in median VO2 and RQ were not different between groups. CONCLUSION: The VO2: lactate ratio was significantly higher in survivors, while there was no association between median VO2 alone and survival. There was a significant difference in change in VCO2 over time between survivors and non-survivors.

AB - INTRODUCTION: Mitochondrial dysfunction leading to impairment of oxygen extraction, referred to as cytopathic hypoxia, contributes to morbidity in sepsis. Oxygen consumption (VO2) may be a useful measure of the severity of cytopathic hypoxia. We monitored VO2 and carbon dioxide production (VCO2) in septic patients and investigated the association with hospital survival. METHODS: We retrospectively identified adult (≥18 years) septic patients from a larger prospective observational cohort of critically ill patients on mechanical ventilation. A gas-exchange monitor recorded continuous VO2 and VCO2 for up to 48 hours. We then tested the association of median VO2, VCO2, respiratory quotient (RQ) and the VO2: lactate ratio with survival. RESULTS: A total of 46 septic patients were included in the analysis, of whom 28 (61%) survived. Overall median VO2 was not associated with survival (3.72 mL/kg/min [IQR: 3.39, 4.92] in survivors and 3.42 mL/kg/min [IQR: 2.97, 5.26] in non-survivors, p = 0.12). The overall median VCO2 and RQ were also not associated with survival. Adjusting for age and the presence of shock did not change these results. The VO2: lactate ratio was associated with survival (adjusted OR 2.17 [95% CI 1.12, 4.22] per unit increase in ratio, p = 0.03). The percent change in median VCO2 was 11.6% [IQR: -8.2, 28.7] in survivors compared to -8.3% [IQR: -18.0, 4.7] in non-survivors (p = 0.03). The percent changes in median VO2 and RQ were not different between groups. CONCLUSION: The VO2: lactate ratio was significantly higher in survivors, while there was no association between median VO2 alone and survival. There was a significant difference in change in VCO2 over time between survivors and non-survivors.

UR - http://www.scopus.com/inward/record.url?scp=85102290620&partnerID=8YFLogxK

U2 - 10.1097/shk.0000000000001661

DO - 10.1097/shk.0000000000001661

M3 - Journal article

C2 - 32881760

VL - 55

SP - 775

EP - 781

JO - Shock

JF - Shock

SN - 1073-2322

IS - 6

ER -