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Tissue oxygen saturation is predictive of lactate clearance in patients with circulatory shock
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Tissue oxygen saturation is predictive of lactate clearance in patients with circulatory shock
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Tissue oxygen saturation is predictive of lactate clearance in patients with circulatory shock
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Journal Article
Tissue oxygen saturation is predictive of lactate clearance in patients with circulatory shock
2023
Overview
Background
Tissue oxygen saturation (StO
2
) decrease could appear earlier than lactate alteration. However, the correlation between StO
2
and lactate clearance was unknown.
Methods
This was a prospective observational study. All consecutive patients with circulatory shock and lactate over 3 mmol/L were included. Based on the rule of nines, a BSA (body surface area) weighted StO
2
was calculated from four sites of StO
2
(masseter, deltoid, thenar and knee). The formulation was as follows: masseter StO
2
× 9% + (deltoid StO
2
+ thenar StO
2
) × (18% + 27%)/ 2 + knee StO
2
× 46%. Vital signs, blood lactate, arterial and central venous blood gas were measured simultaneously within 48 h of ICU admission. The predictive value of BSA-weighted StO
2
on 6-hour lactate clearance > 10% since StO
2
initially monitored was assessed.
Results
A total of 34 patients were included, of whom 19 (55.9%) had a lactate clearance higher than 10%. The mean SOFA score was lower in cLac ≥ 10% group compared with cLac < 10% group (11 ± 3 vs. 15 ± 4, p = 0.007). Other baseline characteristics were comparable between groups. Compared to non-clearance group, StO
2
in deltoid, thenar and knee were significantly higher in clearance group. The area under the receiver operating curves (AUROC) of BSA-weighted StO
2
for prediction of lactate clearance (0.92, 95% CI [Confidence Interval] 0.82-1.00) was significantly higher than StO
2
of masseter (0.65, 95% CI 0.45–0.84; p < 0.01), deltoid (0.77, 95% CI 0.60–0.94; p = 0.04), thenar (0.72, 95% CI 0.55–0.90; p = 0.01), and similar to knee (0.87, 0.73-1.00; p = 0.40), mean StO
2
(0.85, 0.73–0.98; p = 0.09). Additionally, BSA-weighted StO
2
model had continuous net reclassification improvement (NRI) over the knee StO
2
and mean StO
2
model (continuous NRI 48.1% and 90.2%, respectively). The AUROC of BSA-weighted StO
2
was 0.91(95% CI 0.75-1.0) adjusted by mean arterial pressure and norepinephrine dose.
Conclusions
Our results suggested that BSA-weighted StO
2
was a strong predictor of 6-hour lactate clearance in patients with shock.
