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Predictive significance of tissue hypoperfusion markers in different shock types in low income countries

Prädiktive Signifikanz von Markern für Gewebehypoperfusion bei unterschiedlichen Schockarten in Ländern mit geringem Einkommen

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Abstract

The most common condition that brings patients to the medical intensive care unit (MICU) is hemodynamic instability, accompanied by tissue hypoperfusion. In order to make easier and quicker diagnosis of this syndrome marker tissue hypoperfusion is monitored. The aim of this study is to determine the prognostic significance of the level of lactate, lactate clearance, central venous oxygen saturation (ScvO2) and venous-to-arterial carbon dioxide difference (∆pCO2) in two time periods in critically ill patients with acute circulatory failure in low income countries. This is a prospective study for a period of 8 months that included all patients with signs of cardiovascular system failure and tissue hypoperfusion. The study included 82 patients with the mean age of 64 years, of which 37% were women. The values of the lactate in surviving patients who had some form of non-septic shock at the zero hour (T0) were T0 = 6.31 ± 5.15, and at the sixth hour after reanimation the values (T6) were T6 = 3.71 ± 3.62 (p < 0.05), while the lactate levels in the group of non-survivors were T0 = 6.64 ± 7.55 and T6 = 9.41 ± 9.51; (p > 0.05). The main conclusion of this study is that the serum lactate concentration in patients who developed some form of non-septic shock has the highest predictive significance compared to the other two markers of tissue hypoperfusion (venous-to-arterial carbon dioxide difference and central venous oxygen saturation).

Zusammenfassung

Die häufigste Erkrankung, welche eine Versorgung der Patienten auf der Intensivstation erforderlich macht, ist die hämodynamische Instabilität, begleitet von einer Gewebehypoperfusion. Um einfacher und schneller zur Diagnose dieses Syndroms zu gelangen, wird der Marker für Gewebehypoperfusion kontrolliert. Das Ziel dieser Studie ist die Bestimmung der prognostischen Signifikanz der Laktatkonzentration, Laktat-Clearance, zentralvenösen Sauerstoffsättigung (ScvO2) und der arteriovenösen Kohlendioxid-Differenz (∆pCO2) in zwei Zeiträumen bei kritisch kranken Patienten mit akutem Kreislaufversagen in Ländern mit geringem Einkommen. Es handelt sich hierbei um eine prospektive Studie über einen Zeitraum von 8 Monaten, in die alle Patienten mit Zeichen eines Herz-Kreislauf-Versagens und Gewebehypoperfusion eingeschlossen wurden. Insgesamt wurden 82 Patienten mit einem mittleren Alter von 64 Jahren in die Studie eingeschlossen, von denen 37 % weiblich waren. Die Laktatwerte bei überlebenden Patienten, die zum Zeitpunkt 0 (T0) eine Form nichtseptischen Schocks erlitten hatten, betrugen T0 = 6,31 ± 5,15. Sechs Stunden nach Reanimation (T6) lagen die Laktatwerte bei T6 = 3,71 ± 3,62 (p < 0,05), während sie in der Gruppe der Nichtüberlebenden T0 = 6,64 ± 7,55 sowie T6 = 9,41 ± 9,51; (p > 0,05) betrugen. Die wichtigste Schlussfolgerung dieser Studie ist, dass die Serumlaktatkonzentration bei Patienten, die eine Form nichtseptischen Schocks erlitten hatten, im Vergleich zu den anderen beiden Markern für Gewebehypoperfusion (arteriovenöse Kohlendioxid-Differenz und zentralvenöse Sauerstoffsättigung) die höchste prädiktive Signifikanz hatten.

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Abbreviations

∆pCO2 :

Venous-to-arterial carbon dioxide differences

FiO2:

Fraction of inspired oxygen

MAP:

Mean arterial pressure

MICU:

Medical intensive care unit

PEEP:

Positive end-expiratory pressure

SAPS II Score:

Simplified Acute Physiology Score

ScvO2 :

Central venous oxygen saturation

SOFA Score:

Sequential Organ Failure Assessment

UN:

United Nations

WHO:

World Health Organization

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Authors and Affiliations

  1. Medical Intensive Care Unit, University Clinical Center of the Republic of Srpska, Dvanaest beba bb, 78000, Banja Luka, Bosnia and Herzegovina

    D. Momcicevic, T. Kovacevic, S. Dragic, J. Cavka & P. Kovacevic

  2. Faculty of medicine, University of Banja Luka, Banja Luka, Bosnia and Herzegovina

    D. Momcicevic, T. Kovacevic & P. Kovacevic

  3. Pan-European University “Apeiron”, Banja Luka, Bosnia and Herzegovina

    S. Dragic

Authors
  1. D. Momcicevic
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  2. T. Kovacevic
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  4. J. Cavka
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  5. P. Kovacevic
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Correspondence to D. Momcicevic.

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Conflict of interest

D. Momcicevic, T. Kovacevic, S. Dragic, J. Cavka and P. Kovacevic declare that they have no competing interests.

All procedures performed in studies involving human participants or on human tissue were in accordance with the ethical standards of the institutional and/or national research committee and with the 1975 Helsinki declaration and its later amendments or comparable ethical standards. Informed consent was obtained from all individual participants included in the study.

Ethical approval and informed consent

The study was approved by the Ethics Committee of the University Clinical Center of the Republic of Srpska. The informed consent was signed by the authorized representative of the patients.

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Momcicevic, D., Kovacevic, T., Dragic, S. et al. Predictive significance of tissue hypoperfusion markers in different shock types in low income countries. Med Klin Intensivmed Notfmed 115, 307–311 (2020). https://doi.org/10.1007/s00063-019-0592-5

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