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Is Carboxyhaemoglobin an Effective Bedside Prognostic Tool for Sepsis and Septic Shock Patients?

Bianca-Liana Grigorescu

Bianca-Liana Grigorescu

Department of Anesthesia and Intensive Care, George Emil Palade University of Medicine, Pharmacy, Science, and Technology of Targu MuresRomania
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Grigorescu, Bianca-Liana
, 
Oana Coman

Oana Coman

Department of Simulation Applied in Medicine, George Emil Palade University of Medicine, Pharmacy, Science, and Technology of Targu MuresRomania
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Coman, Oana
, 
Anca Meda Văsieșiu

Anca Meda Văsieșiu

Department of Infectious Diseases, George Emil Palade University of Medicine, Pharmacy, Science, and Technology of Targu MuresRomania
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Văsieșiu, Anca Meda
, 
Anca Bacârea

Anca Bacârea

Department of Pathophysiology, George Emil Palade University of Medicine, Pharmacy, Science, and Technology of Targu MuresRomania
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Bacârea, Anca
, 
Marius Petrișor

Marius Petrișor

Department of Simulation Applied in Medicine, George Emil Palade University of Medicine, Pharmacy, Science, and Technology of Targu MuresRomania
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Petrișor, Marius
, 
Irina Săplăcan

Irina Săplăcan

County Emergency Clinical HospitalTargu Mures, Romania
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Săplăcan, Irina
 und 
Raluca Ștefania Fodor

Raluca Ștefania Fodor

Department of Anesthesia and Intensive Care, George Emil Palade University of Medicine, Pharmacy, Science, and Technology of Targu MuresRomania
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Fodor, Raluca Ștefania
  
14. Nov. 2023
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Artikel-Kategorie: Research Article
Online veröffentlicht: 14. Nov. 2023
Seitenbereich: 239 - 251
Eingereicht: 22. Sept. 2023
Akzeptiert: 22. Okt. 2023
DOI: https://doi.org/10.2478/jccm-2023-0031
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© 2023 Bianca-Liana Grigorescu et al., published by Sciendo
This work is licensed under the Creative Commons Attribution 4.0 International License.

Fig. 1.

Visual description of the study (N – number of patients; SOFA - Sequential Organ Failure Assessment; APACHE II - Acute Physiology and Chronic Health Evaluation II; SAPS II - Simplified Acute Physiology Score II)
Visual description of the study (N – number of patients; SOFA - Sequential Organ Failure Assessment; APACHE II - Acute Physiology and Chronic Health Evaluation II; SAPS II - Simplified Acute Physiology Score II)

Figure 2.

Distribution by age
Distribution by age

Figure 3.

Distribution by mortality
Distribution by mortality

Fig. 4.

Positive correlation between SOFA vs. APACHE II and SOFA vs. SAPS II. No correlation between SOFA vs. NLR and SOFA vs. COHb levels on D1 (SOFA – Sequential Organ Failure Assessment; APACHE II – Acute Physiology and Chronic Health Evaluation II; SAPS II – Simplified Acute Physiology Score II; NLR – Neutrophil-Lymphocytes Ratio; COHb – Carboxyhaemoglobin; D1 – day 1)
Positive correlation between SOFA vs. APACHE II and SOFA vs. SAPS II. No correlation between SOFA vs. NLR and SOFA vs. COHb levels on D1 (SOFA – Sequential Organ Failure Assessment; APACHE II – Acute Physiology and Chronic Health Evaluation II; SAPS II – Simplified Acute Physiology Score II; NLR – Neutrophil-Lymphocytes Ratio; COHb – Carboxyhaemoglobin; D1 – day 1)

Fig. 5.

Positive correlation between APACHE II vs. SAPS II. No correlation between APACHE II vs. NLR, APACHE II vs. COHb levels on D1 (APACHE II – Acute Physiology and Chronic Health Evaluation II; SAPS II – Simplified Acute Physiology Score II; NLR – Neutrophil-Lymphocytes Ratio; COHb – Carboxyhaemoglobin; D1 – day 1)
Positive correlation between APACHE II vs. SAPS II. No correlation between APACHE II vs. NLR, APACHE II vs. COHb levels on D1 (APACHE II – Acute Physiology and Chronic Health Evaluation II; SAPS II – Simplified Acute Physiology Score II; NLR – Neutrophil-Lymphocytes Ratio; COHb – Carboxyhaemoglobin; D1 – day 1)

Fig. 6.

No correlation between SAPS II vs. NLR, SAPS II vs. COHb levels on D1 (SAPS II – Simplified Acute Physiology Score II; NLR – Neutrophil-Lymphocytes Ratio; COHb – Carboxyhaemoglobin; D1 – day 1)
No correlation between SAPS II vs. NLR, SAPS II vs. COHb levels on D1 (SAPS II – Simplified Acute Physiology Score II; NLR – Neutrophil-Lymphocytes Ratio; COHb – Carboxyhaemoglobin; D1 – day 1)

Fig. 7.

Negative correlation between NLR vs. COHb on D1 (NLR – Neutrophil-Lymphocytes Ratio; COHb – Carboxyhaemoglobin; D1 – day 1)
Negative correlation between NLR vs. COHb on D1 (NLR – Neutrophil-Lymphocytes Ratio; COHb – Carboxyhaemoglobin; D1 – day 1)

Fig. 8.

Positive correlation between SOFA vs. APACHE II, SOFA vs. SAPS II. No correlation between SOFA vs. NLR and SOFA vs. COHb levels on D5 (SOFA – Sequential Organ Failure Assessment; APACHE II – Acute Physiology and Chronic Health Evaluation II; SAPS II – Simplified Acute Physiology Score II; NLR – Neutrophil-Lymphocytes Ratio; COHb – Carboxyhaemoglobin; D5 – day 5)
Positive correlation between SOFA vs. APACHE II, SOFA vs. SAPS II. No correlation between SOFA vs. NLR and SOFA vs. COHb levels on D5 (SOFA – Sequential Organ Failure Assessment; APACHE II – Acute Physiology and Chronic Health Evaluation II; SAPS II – Simplified Acute Physiology Score II; NLR – Neutrophil-Lymphocytes Ratio; COHb – Carboxyhaemoglobin; D5 – day 5)

Fig. 9.

Positive correlation between APACHE II vs. SAPS II. No correlation between APACHE II vs. NLR, APACHE II vs. COHb levels on D5 (APACHE II – Acute Physiology and Chronic Health Evaluation II; SAPS II – Simplified Acute Physiology Score II; NLR – Neutrophil-Lymphocytes Ratio; COHb – Carboxyhaemoglobin; D5 – day 5)
Positive correlation between APACHE II vs. SAPS II. No correlation between APACHE II vs. NLR, APACHE II vs. COHb levels on D5 (APACHE II – Acute Physiology and Chronic Health Evaluation II; SAPS II – Simplified Acute Physiology Score II; NLR – Neutrophil-Lymphocytes Ratio; COHb – Carboxyhaemoglobin; D5 – day 5)

Fig. 10.

No correlation between SAPS II vs. NLR, SAPS II vs. COHb levels on D5 (SAPS II – Simplified Acute Physiology Score II; NLR – Neutrophil-Lymphocytes Ratio; COHb – Carboxyhaemoglobin; D5 – day 5)
No correlation between SAPS II vs. NLR, SAPS II vs. COHb levels on D5 (SAPS II – Simplified Acute Physiology Score II; NLR – Neutrophil-Lymphocytes Ratio; COHb – Carboxyhaemoglobin; D5 – day 5)

Fig. 11.

No correlation between NLR vs. COHb on D5 (NLR – Neutrophil-Lymphocytes Ratio; COHb – Carboxyhaemoglobin; D5 – day 5)
No correlation between NLR vs. COHb on D5 (NLR – Neutrophil-Lymphocytes Ratio; COHb – Carboxyhaemoglobin; D5 – day 5)

Fig. 12.

Evolution of NLR on D1 and D5 in sepsis survivors and non-survivors (NLR – Neutrophil-Lymphocytes Ratio; D1 – day 1; D5 – day 5)
Evolution of NLR on D1 and D5 in sepsis survivors and non-survivors (NLR – Neutrophil-Lymphocytes Ratio; D1 – day 1; D5 – day 5)

Fig. 13.

Evolution of NLR on D1 and D5 in septic shock survivors and non-survivors (NLR – Neutrophil-Lymphocytes Ratio; SS – septic shock; D1 – day 1; D5 – day 5)
Evolution of NLR on D1 and D5 in septic shock survivors and non-survivors (NLR – Neutrophil-Lymphocytes Ratio; SS – septic shock; D1 – day 1; D5 – day 5)

Fig. 14.

Evolution of COHb (%) on D1 and D5 in sepsis survivors and non-survivors (COHb – Carboxyhaemoglobin; D1 – day 1; D5 – day 5)
Evolution of COHb (%) on D1 and D5 in sepsis survivors and non-survivors (COHb – Carboxyhaemoglobin; D1 – day 1; D5 – day 5)

Fig. 15.

Evolution of COHb (%) on D1 and D5 in septic shock survivors and non-survivors (COHb – Carboxyhaemoglobin; SS – septic shock; D1 – day 1; D5 – day 5)
Evolution of COHb (%) on D1 and D5 in septic shock survivors and non-survivors (COHb – Carboxyhaemoglobin; SS – septic shock; D1 – day 1; D5 – day 5)

Descriptive statistics on D1

SOFA APACHE II (points) SAPS II (points) NLR COHb
Minimum 1.000 7.000 17.00 0.7420 0.000
25% Percentile 6.000 14.00 34.50 8.236 0.4250
Median 9.000 22.00 56.00 14.14 1.100
75% Percentile 13.00 30.00 72.00 25.01 1.500
Maximum 19.00 44.00 118.0 59.67 2.500
Range 18.00 37.00 101.0 58.93 2.500
Mean 9.459 22.30 54.61 17.06 1.080
Std.Deviation 4.700 9.426 21.84 11.76 0.6356
Std. Error of Mean 0.6017 1.207 2.796 1.505 0.08206

Site of infection and aetiology of infection of patients included in the study_

Site of infection Number of patients Aetiology Number of patients
Pulmonary 36 Pneumonia / Bronchopneumonia 33
Abdominal 27 Peritonitis 12
Cutaneous 5 Intestinal obstruction 5
Urinary tract 4 Enterocolitis 2
Bloodstream 3 Sepsis / septic shock of unknown origin 2
Soft tissue 3 Pancreatitis 3
Biliary tract 1 Urinary tract infection 2
Unspecified 1 Cutaneous abscess 5
Prosthetic joint infection 1

Descriptive statistics on D5

SOFA APACHE II (points) SAPS II (points) NLR COHb
Minimum 0.000 5.000 15.00 0.7860 0.000
25% Percentile 2.000 11.00 29.00 5.422 0.600
Median 7.000 18.00 46.00 9.005 1.000
75% Percentile 12.00 27.00 61.00 17.87 1.500
Maximum 19.00 34.00 85.00 46.75 17.00
Range 19.00 29.00 70.00 45.96 17.00
Mean 7.359 18.74 45.36 13.03 1.471
Std. Deviation 5.334 9.318 20.40 10.84 2.550
Std. Error of Mean 0.8541 1.492 3.267 1.714 0.3982

Pathogens associated with infection of patients involved in the study_

Pathogens Number of patients
Pseudomonas aeruginosa 9
Klebsiella pneumoniae CPE 8
BLSE 2
unspecified 2
Acinetobacter baumanii 13
Proteus vulgaris 2
Enterococcus faecalis 5
Escherichia coli BLSE 4
unspecified 3
Staphylococcus arureus MRSA 1
MSSA 2
Streptococcus pneumoniae 1
Candida spp. 8
Clostridiumdifficile 3
Other 16
MDR Yes 13
No 48

Predictability of mortality by NLR and COHb variation from D1 to D5 of survivors and non-survivors

Survivors (n = 15) Non-survivors (n = 46)
NLRD1 ↓ D5 and COHb D1 ↓ D5 11 9
NLRD1 ↓ D5 and COHb D1 ↑ D5 1 14
NLRD1 ↑ D5 and COHb D1 ↑ D5 2 3
NLRD1 ↑ D5 and COHb D1 ↓ D5 0 4
NLR only on D1 and COHb only on D1 1 16
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