Central Peripheral Temperature Gradient Correlated with the Simultaneous ScvO2 and Lactate Level in Severe Sepsis and Septic Shock Patients

Abstract

Objective: To evaluate whether the central peripheral temperature gradient (CPTG) correlated with the simultaneous central venous oxyhemoglobin saturation (ScvO2) and serum lactate levels in severe sepsis and septic shock patients. Design: A retrospective observational study design was used with temporal artery thermometry (TAT) to measure CPTG. Results: A total of 61 patients with severe sepsis or septic shock in the intensive care unit (ICU) were analyzed and monitored for CPTG, mean arterial pressure (MAP), ScvO2, and lactate level. Four patients were excluded due to peripheral arterial occlusive disease. The correlation between the binary CPTG (high CPTG ≥5℃ and low CPTG＜5℃) and simultaneous ScvO2 and lactate level was evaluated. The effect of coexistent MAP (＜65 mmHg and ≥65 mmHg) on the lactate level and ScvO2 (＜70% or ≥70%) was also investigated. Compared with the low CPTG group, the high CPTG group had lower ScvO2 (60.1±13.6% vs 66.5±12.7%; p=0.001) and higher lactate levels (6.0±4.5 mmol/L vs 3.2±2.1 mmol/L; p＜0.001). The binary CPTG correlated to the ScvO2 (p＜0.001) after adjustment for the effect of MAP. The adjusted mean difference of ScvO2 between those patients with high CPTG and low CPTG was -4.4% (95% confidence interval [CI]: -7.0 to -1.8). The binary CPTG also correlated with the lactate level (p＜0.001) after adjustment for the effect of MAP. The adjusted mean difference of the lactate level between those patients with high CPTG and low CPTG was 2.5 mmol/L (95% CI, 1.6-3.4 mmol/L). In a multivariate analysis predicting the lactate level by the coexistent MAP, binary CPTG, and ScvO2, only the binary CPTG and MAP (＜65 mmHg or ≥65 mmHg) were independent predictors (both p＜0.001). Conclusions: CPTG correlated with the ScvO2 and serum lactate level in severe sepsis and septic shock patients.