Increased admission central venous-arterial CO 2 difference predicts ICU-mortality in adult cardiac surgery patients

• Published in: Heart & lung Vol. 48; no. 5; p. 421
• Main Authors: Zante, Bjoern, Reichenspurner, Hermann, Kubik, Mathias, Schefold, Joerg C, Kluge, Stefan
• Format: Journal Article
• Language: English
• Published: United States 01.09.2019
• Subjects: Aged; Arteries; Blood Gas Analysis; Carbon Dioxide - blood; Cardiac Surgical Procedures; Critical Illness - epidemiology; Female; Germany - epidemiology; Hospital Mortality - trends; Humans; Intensive Care Units; Male; Middle Aged; Postoperative Period; Prognosis; Resuscitation - methods; Retrospective Studies; ROC Curve; Veins; Germany; Carbon dioxide content difference; Hemodynamic; Sepsis; Cardiac output; Veno-arterial CO difference; Tissue oxygenation
• ISSN: 1527-3288

Invasive procedures such as cardiac surgery are associated with perioperative dysfunction of macrocirculation and/or microcirculation and organ failures. Maintenance or resuscitation of an adequate macrocirculation and/or microcirculation is thus crucial in patients after cardiac surgery. We investigated the prognostic power of early central venous-arterial carbon dioxide pressure difference (delta-pCO2) after cardiac surgery. Retrospective analysis of data from 1,019 cardiac surgery patients treated in the ICU of a tertiary medical care academic center. Clinical outcomes and laboratory measures including metabolic indices and calculated delta-pCO were assessed. Receiver operating characteristic (ROC) curves were generated and sensitivity / specificity analysis was performed. Univariate and multivariate regression models were analyzed. The area under the ROC curve for delta-pCO to predict ICU mortality was 0.72 (sensitivity 65% / specificity 76%) with an optimal delta-pCO cut-off value of 8.6 mmHg. In multivariate regression, delta-pCO was associated with increased ICU mortality (HR 3.72, 95%-CI 1.3-10.66, p = 0.02). After adjustment for typical confounders, delta-pCO remained as independent predictor of ICU mortality after cardiac surgery. In a retrospective data analysis in a large sample of adult post cardiac surgery patients treated in the ICU, we observed that admission central venous-arterial delta-pCO independently predicts ICU mortality. Delta-pCO might thus contribute risk stratification in ICU patients after cardiac surgery.