Correlation of ScvO₂, lactate clearance rate, and ultrasound-measured IVC-RVI during fluid resuscitation in patients with severe sepsis and their predictive value for prognosis

Objective:To investigate the correlation between central venous oxygen saturation(ScvO₂), lactic acid clearance rate, and the variation of inferior vena cava respiration (IVC-RVI) measured by ultrasound in patients with severe sepsis during fluid resuscitation, so as to provide reference for early clinical intervention.Methods:A total of 60 patients with severe sepsis were selected from Zigong First People’s Hospital from December 2020 to December 2022.All patients were treated with fluid resuscitation according to early goal-directed therapy(EGDT)and 6-h sepsis bunging therapy.ScvO₂ and lactate clearance rate was monitored, and IVC-RVI was calculated by ultrasound examination.The relationship between ScvO₂, lactate clearance rate, IVC-RVI and EGDT treatment standard was analyzed.ScvO₂, lactate clearance rate and IVC-RVI were compared at 6 h, 12 h and 24 h after resuscitation in patients with different prognosis to analyze their prognostic evaluation value.Results:At 6 h after resuscitation, the ScvO₂ and lactate clearance rate of the non-conforming group were lower than those of the conforming group, while the IVC-RVI was higher than that of the conforming group (P< 0.05).The risk of substandard EGDT treatment in patients with low ScvO₂ and lactate clearance at 6 h after resuscitation was 7.500 times and 4.667 times higher than that in patients with high level, respectively.The risk of substandard EGDT treatment in patients with high level of IVCRVI was 3.250 times higher than that in patients with low level.The ScvO₂ and lactate clearance rate in death patients was lower than that in survival patients at 6 h, 12 h and 24 h after resuscitation, while the IVC-RVI was higher than that in survival patients (P< 0.05).The combined prediction AUC of ScvO₂, lactate clearance rate and IVC-RVI at 6 h, 12 h and 24 h after resuscitation was 0.856, 0.892 and 0.933, respectively, which was significantly larger than the single index at each time point, and the combined prediction AUC at 24 h after resuscitation was > 12 h> 6 h after resuscitation (P< 0.05).The ScvO₂ and lactate clearance rate of patients with severe sepsis were negatively correlated with IVC-RVI at 6 h, 12 h and 24 h after resuscitation(P< 0.05).Conclusion:ScvO₂, lactate clearance rate and IVC-RVI in fluid resuscitation of patients with severe sepsis have a high value in evaluating the efficacy of fluid resuscitation, providing evidence for early prognosis in clinical, so as to carry out targeted follow-up treatment and improve the survival rate.