Persistence of Central Venous Oxygen Desaturation During Early Sepsis Is Associated With Higher Mortality: A Retrospective Analysis of the ALBIOS Trial.

Abstract

Relevance of low (< 70%) central venous oxygen saturation (Scvo₂) during early sepsis has been recently questioned by three negative trials (Protocol-Based Care for Early Septic Shock, Australasian Resuscitation in Sepsis Evaluation, and Protocolized Management in Sepsis) on early goal-directed therapy; however, subjects included in those trials had Scvo₂ at enrollment as high as 71 ± 13%, 73 ± 11%, and 70 ± 12%. Here we assess the association between Scvo₂ < 70% at 6 h and 90-day mortality in subjects enrolled in the Albumin Italian Outcome Sepsis (ALBIOS) trial, focusing on those with initial Scvo₂ < 70%. Regardless of treatment assignment (to receive albumin or not), all subjects enrolled in the ALBIOS trial received early goal-directed therapy aiming for Scvo₂ ≥ 70% at 6 h. Using multivariable logistic regression analyses, we tested the association between Scvo₂ < 70% at 6 h and 90-day mortality in those with initial Scvo₂ < 70% (n = 514) or ≥ 70% (n = 961). Scvo₂ < 70% at 6 h was independently associated with higher 90-day mortality in subjects with initial Scvo₂ < 70% (OR, 1.84; 95% CI, 1.19-2.85; P = .007) but not in those with initial Scvo₂ ≥ 70% (OR, 1.25; 95% CI, 0.79-1.95; P = .357). Scvo₂ < 70% at enrollment and at 6 h was associated with history and/or signs of cardiac dysfunction but not with greater severity of disease or more aggressive resuscitation (required per protocol). In the ALBIOS trial, persistence of low Scvo₂ was associated with higher 90-day mortality, possibly because it reflected underlying cardiac dysfunction. Subjects with Scvo₂ < 70% may benefit most from individually tailored interventions aimed at normalizing the balance between systemic oxygen delivery and consumption. ClinicalTrials.gov; No. NCT00707122; URL: www.clinicaltrials.gov.