الفهرس 
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Abstract
Summary
Sepsis refers to life threatening organ dysfunction caused by a dysregulated host response to infection..
The aim of this Study was to test a hypothesis that mortality prediction in patients with sepsis can be done using veno-arterial CO2 gradient as compared to central venous oxygen saturation.
This study was a prospective study was conducted on 30 adult critically ill patients who were admitted to General ICU of Ain Shams University hospitals, either in sepsis or septic shock on admission. They were in the period from October 2017- April 2018. An informed written consent was obtained from the patients and /or their guardians before starting this study. Inclusion Criteria were patients more than 18 years old that were critically ill either in sepsis or septic shock. Exclusion Criteria were Patients less than 18 years old, patient or relatives who refused to be included in this study, those with an absolute contraindication to chest or neck central venous catheter and pregnant patients.
All patients were subjected to the followings:
Full history: including personal data, special habits as smoking, and co-morbidities as diabetes, hypertension, renal impairment or cardiac disease. Hemodynamic monitoring: Daily hemodynamic monitoring of the patients, Daily clinical examination: daily full clinical examination, Lab profile: Routine laboratory investigations on day of admission and during stay in ICU, Cultures and sensitivity according to source of sepsis.
All patients were exposed to close observation, and central venous oxygen saturation and veno-arterial carbon dioxide gradient were measured on admission and at 6,12,18,24,30,36,42,48 hours after admission Also mortality outcome was observed
Patient’s data were collected as regard; Causes of admission,, Infection Data, Infection site, Pathogenic Bacteria, morbidity and mortality, and. Scoring System: At ICU admission and (SOFA) scale.
Results of this study shows that 12 patients (40%) were males and 18 patients (60%) were females. The most frequent comorbidities were DM (53.3%) followed by Hypertension (50%) and COPD (36.7%). Sources of infection were mostly Respiratory 80% then urinary 26.7%. The least Sources of infection were CNS infection and abdominal sepsis 20%. ScvO2 at admission and at hour 6 was a significant predictor of mortality in the studied patients, with cut off values of ≤ 72.5% and ≤ 58.5% respectively. Also, Pv-aCO2 at admission and at hour 6 was a significant predictor of mortality in the studied patients, with cut off values of ≥ 6.95 and ≥ 6.5 respectively. Patients who died had significantly lower ScvO2 values than patients who survived. On the other hand, Patients who died had significantly higher Pv-aCO2 values than patients who survived. There was statistically significant positive correlation between ScvO2 at admission and Pv-aCO2 at admission (r= 0.55, p=0.002). There was a statistically insignificant difference between patients who survived and patients who died regarding Age and Sex (p>0.05)