C02 Gap as a Prognostic Indicator in the suspected Sepsis Patient presenting to an Emergency Department

Sparenberg, S. (Sebastian) (2017) C02 Gap as a Prognostic Indicator in the suspected Sepsis Patient presenting to an Emergency Department. thesis, Medicine.

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Abstract

Background: Sepsis remains the leading cause of death in surgical and medical ICU’s. Sepsis results due to the dysregulated immune response to infection leading to tissue hypoxia and organ dysfunction. Investigating novel prognostic tools that could flag the adverse outcomes in sepsis is of great interest. CO2 GAP, the difference between PaCO2 and EtCO2, is strongly related to cardiac output, pulmonary dead space and ventilation-perfusion mismatch. A study performed on a cohort of unwell patients with shortness of breath showed promising results in the validity of CO2 GAP as a prognostic tool for adverse outcomes of ventilatory support and mortality. This study aims to assess the validity of CO2 GAP as a prognostic tool for adverse outcomes in patients presenting to the ED with suspected sepsis. Secondarily, we wanted to benchmark this performance for adverse outcomes to other established bedside sepsis severity markers such as lactate. Methods: This is a prospective cohort study conducted in Westmead Emergency Department in Sydney, Australia, with a targeted patient population of 125 patients. ABG and EtCO2 measurements were conducted on the patient after initial screening using New South Wales’ “Sepsis Kills” protocol. The primary outcome for analysis was SOFA≥2 sepsis and secondary outcome was adverse outcome during in-hospital stay (death or intensive care unit length of stay ≥ 72 hours). All patients underwent investigations and management as per usual guidelines with no alteration on basis of the CO2 GAP results. Results: A study population of 124 out of 125 initially recruited patients was analysed for the study. The prevalence of SOFA≥ 2 sepsis was 45.2% (n=56) and 18.6% (n=23) participants had adverse outcomes. Correlation of CO2 GAP at cut off 9.7 and SOFA≥ 2 sepsis revealed significance (AUC of 0.608; 95%CI: 0.516 to 0.694; p= 0.0024). We report significance when correlating CO2 GAP ≥ 5 with ICU admission and/or death AUC of 0.64 (95% CI 0.547-0.722), in comparison, a lactate level greater than 2mmol/L revealed no significant correlation with AUC of 0. 59 (95%CI: 0. 58 to 0. 75; p= 0. 1071) for SOFA≥2 sepsis, whilst a significant correlation was found between lactate levels ≥2mmol/L predictive for ICU admission and/or death (AUC: 0. 67 95%CI: 0.49-0.67; p= 0. 004). No statistically significant differences in AUROC were found between CO2 GAP and lactate levels for both outcomes. Conclusion: CO2 GAP shows promising value as prognostic indicator but no statistical difference was reached when compared to lactate. This study found that CO2 GAP ≥10 has modest correlation with Sepsis and CO2 GAP ≥ 5 with ICU/death outcomes. Further investigations on larger cohort sizes should investigate the validity of CO2 GAP as a prognostic tool in the risk stratification of suspected sepsis patients presenting to the emergency department.

Item Type:	Thesis (Thesis)
Supervisor name:	Supervisors and Shetty, Amith MD Emergency Physician and Elkhaloufi, Y. MD Emergency Physician and Emergency Department Westmead Hospital, Westmead (Sydney and University of Sydney
Faculty:	Medical Sciences
Date Deposited:	25 Jun 2020 10:45
Last Modified:	25 Jun 2020 10:45
URI:	https://umcg.studenttheses.ub.rug.nl/id/eprint/638

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