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

Zante, Björn; Reichenspurner, Hermann; Kubik, Mathias; Schefold, Jörg Christian; Kluge, Stefan (2019). Increased admission central venous-arterial CO difference predicts ICU-mortality in adult cardiac surgery patients. Heart & lung, 48(5), pp. 421-427. Elsevier 10.1016/j.hrtlng.2019.05.015

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BACKGROUND

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.

METHODS

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.

RESULTS

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.

CONCLUSIONS

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.

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