End-tidal carbon dioxide is associated with mortality and lactate in patients with suspected sepsis

    Authors

    C. L. Hunter; S. Silvestri; M. Dean; J. L. Falk;L. Papa

    Comments

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    Abbreviated Journal Title

    Am. J. Emerg. Med.

    Keywords

    SEPTIC SHOCK; LACTIC-ACIDOSIS; CHILDREN; CO2; Emergency Medicine

    Abstract

    Objective: Exhaled end-tidal carbon dioxide (ETCO2) concentration is associated with lactate levels in febrile patients. We assessed the association of ETCO2 with mortality and lactate levels in patients with suspected sepsis. Methods: This was a prospective observational study. We enrolled 201 adult patients presenting with suspected infection and 2 or more systemic inflammatory response syndrome criteria. Lactate and ETCO2 were measured and analyzed with patient outcomes. Results: The area under the receiver operator characteristics curve (AUC) was 0.75 (confidence interval [CI], 0.65-0.86) for lactate and mortality and 0.73 (CI, 0.61-0.84) for ETCO2 and mortality. When analyzed across the different categories of sepsis, the AUCs for lactate and mortality were 0.61 (CI, 0.36-0.87) for sepsis, 0.69 (CI, 0.48-0.89) for severe sepsis, and 0.74 (CI, 0.55-0.93) for septic shock. The AUCs for ETCO2 and mortality were 0.60 (CI, 0.37-0.83) for sepsis, 0.67 (CI, 0.46-0.88) for severe sepsis, and 0.78 (CI, 0.59-0.96) for septic shock. There was a significant inverse relationship between ETCO2 and lactate in all categories, with correlation coefficients of -0.421 (P < .001) in the sepsis group, -0.597 (P < .001) in the severe sepsis group, and -0.482 (P=.011), respectively. Adjusted odds ratios were calculated, demonstrating 3 significant predictors of mortality: use of vasopressors 16.4 (95% CI, 1.80-149.2), mechanical ventilation 16.4 (95% CI, 3.13-85.9), and abnormal ETCO2 levels 6.48 (95% CI, 1.06-39.54). Conclusions: We observed a significant association between ETCO2 concentration and in-hospital mortality in emergency department patients with suspected sepsis across a range of disease severity. (C) 2013 Elsevier Inc. All rights reserved.

    Journal Title

    American Journal of Emergency Medicine

    Volume

    31

    Issue/Number

    1

    Publication Date

    1-1-2013

    Document Type

    Article

    Language

    English

    First Page

    64

    Last Page

    71

    WOS Identifier

    WOS:000312954600011

    ISSN

    0735-6757

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