Role of SatO2, PaO2/FiO2 Ratio and PaO2 to Predict Adverse Outcome in COVID-19: A Retrospective, Cohort Study
Abstract
:1. Introduction
2. Materials and Methods
2.1. Study Design and Settings
2.2. Particitants and Data Collection
- -
- Age;
- -
- Gender;
- -
- Coexisting disorder (hypertension, smoke, hypercholesterolemia, heart failure, COPD, pulmonary restrictive diseases, coagulopathies, immunodepression, diabetes, vascular-artery disease, chronic kidney disease, active solid cancer, active hematological disorder);
- -
- Medications (ACE inhibitors, steroids, oral anticoagulant);
- -
- Vital parameters at admission (systolic pressure, diastolic pressure, SatO2%, heart rate, respiratory rate, temperature);
- -
- Laboratory test at admission (white cell count, neutrophils, lymphocytes, platelets, aPTT, INR, d-dimer, fibrinogen, CRP, procalcitonin, lactate deydrogenase, IL-6, creatine-kinase, ferritin, troponin, creatinine, NT-probnp);
- -
- Arterial blood gas analysis: pH, pCO2, PaO2, PaO2/FiO2 ratio;
- -
- Number of patients requiring supplemental oxygen via face mask and those requiring non-invasive ventilation/C-PAP helmet.
2.3. Outcomes Measures
- SatO2 < 94% versus SatO2 ≥ 94% (value chosen on the basis of WHO indication).
- PaO2/FiO2 ratio subdivided using the threshold of 100–200–300 according to the Berlin criteria of ARDS.
- PaO2 < 60 and >100 mmHG (out of normal range) versus PaO2 60–100 (in range).
2.4. Data Analysis and Statistical Methods
3. Results
3.1. Characteristic of Patients
3.2. Outcome and Blood Gas Analysis
Logistic Analysis Results
4. Discussion
5. Limitations
6. Conclusions
Author Contributions
Funding
Institutional Review Board Statement
Informed Consent Statement
Data Availability Statement
Acknowledgments
Conflicts of Interest
Abbreviations
ARDS | acute respiratory distress syndrome |
HFNC | high flow nasal cannula |
C-PAP | continuous positive air pressure |
NIV | non-invasive ventilation |
ICU | Intensive Care Unit |
DO2 | tissue oxygen delivery |
VO2 | cellular oxygen consumption |
ROS | reactive oxygen species |
SatO2 | Peripheral oxygen saturation |
ABG | arterial blood gas |
PaO2 | partial pressure of arterial oxygen |
PaO2/FiO2 | partial pressure of arterial oxygen/fraction of inspired oxygen rate |
RT-PCR | reverse transcription of polymerase chain reaction |
COPD | Chronic obstructive pulmonary disease |
ACE | angiotensin-converting enzyme |
aPTT | activated partial thromboplastin time |
INR | International Normalized Ratio |
NT-proBNP | N-Terminal Fragment of the Prohormone Brain-Type Natriuretic Peptide |
IOT | mechanical ventilation |
IQR | interquartile range |
OR | odds ratio |
CIs | confidence intervals |
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All Participants (n = 483) | GROUP A Admitted to Hospital Not Requiring C-PAP (n = 217) | GROUP B Admitted to Hospital on C-PAP (n = 140) | |
---|---|---|---|
Age, years | 74 (61–83) | 77 (61–85) | 69 (61–77) |
Gender | |||
Men Woman | 278/483 (57.56%) 205/483 (42.44%) | 170/330 (51.52%) 160/333 (48.48%) | 108/153 (70.59%) 45/153 (29.41%) |
Coexisting Disorders | |||
Hypertension | 205/483 (42.44%) | 132/330 (40.00%) | 73/153 (47.71%) |
Smoke | 17/483 (3.52%) | 10/330 (3.03%) | 7/153 (4.58%) |
Hypercholesterolemia | 58/483 (12.01%) | 42/330 (12.73%) | 16/153 (10.46%) |
Heart failure with EF < 50% | 18/483 (3.73%) | 16/330 (4.85%) | 2/153 (1.31%) |
COPD | 28/483 (5.80%) | 21/330 (6.36%) | 7/153 (4.58%) |
Pulmonary restrictive diseases | 2/483 (0.41%) | 1/330 (0.30%) | 1/153 (0.65%) |
Coagulopathy | 3/483 (0.62%) | 2/330 (0.61%) | 1/153 (0.65%) |
Immunodepression (acquired or congenital) | 22/483 (4.55%) | 13/330 (3.94%) | 9/153 (5.88%) |
Diabetes | 49/483 (10.14%) | 26/330 (7.88%) | 23/153 (15.03%) |
Vascular artery diseases | 86/483 (17.81%) | 66/330 (20.00%) | 20/153 (13.07%) |
Chronic kidney diseases | 22/483 (4.55%) | 13/330 (3.94%) | 9/153 (5.88%) |
Medications | |||
ACE-inhibitors | 104/483 (21.53%) | 63/330 (19.09%) | 41/153 (26.80%) |
Steroids | 25/483 (5.18%) | 12/330 (3.64%) | 13/153 (8.50%) |
Active solid cancer | 50/483 (10.35%) | 37/330 (11.21%) | 13/153 (8.50%) |
Active hematological disorders | 27/483 (5.59%) | 18/330 (5.45%) | 9/153 (5.88%) |
Vital parameters at admission | |||
Systolic, mmHg | 130 (117–145) | 130 (116–145) | 130 (120–150) |
Diastolic, mmHg | 75 (65–84) | 75 (65–82) | 77 (68–87) |
SatO2, % | 95 (91–97) | 95 (92–97) | 94 (89–97) |
Heart rate, per minute | 85 (75–99) | 85 (75–99) | 86 (75–98) |
Respiratory rate, per minute | 20 (18–25) | 20 (18–24) | 22 (18–30) |
Temperature, Celsius | 36.9 (36.5–37.7) | 36.8 (36.5–37.7) | 37 (36.5–37.7) |
Laboratory test at admission | |||
White cell count, 10⁹ cells/L | 6.98 (4.94–10.5) | 7.18 (4.96–11.42) | 6.77 (4.94–9.76) |
Neutrophil, 10⁹ cells/L | 5.3 (3.6–8.5) | 5.4 (3.5–9) | 5.25 (3.8–8.1) |
Lymphocyte, 10⁹ cells/L | 0.9 (0.6–1.2) | 0.9 (0.6–1.3) | 0.8 (0.5–1.05) |
Hemoglobin, g/L | 135.5 (122–147) | 133 (119.5–144.5) | 141 (125–150) |
Platelets, 10⁹ cells/L | 200 (153–266) | 212 (156–275) | 182 (139–243) |
aPTT, second | 33.1 (30.6–35.5) | 32.7 (30.3–35.7) | 33.45 (31.35–35.4) |
INR | 1.2 (1.12–1.32) | 1.2 (1.11–1.34) | 1.21 (1.14–1.29) |
D-dimer, ng/mL | 1027.5 (613.15–1636) | 1054 (615.7–1969) | 988 (612.6–1388) |
Fibrinogen, g/L | 5.47 (4.43–6.88) | 5.2 (4.23–6.62) | 6.26 (5.04–7.6) |
C-reactive protein, µg/dL | 75.4 (34.6–130) | 64.7 (27.7–124) | 99.15 (54.1–140) |
Procalcitonin, ng/mL | 0.15 (0.06–0.38) | 0.12 (0.05–0.35) | 0.175 (0.1–0.415) |
Lactic dehydrogenase, u/L | 307 (236–408) | 289 (221–380) | 339.5 (272.5–459.5) |
IL-6, ng/L | 638.85 (618.7–674.2) | 632.2 (615.9–663.3) | 655.8 (629.3–699) |
Creatine-kinase, u/L | 101.5 (59–204) | 89 (54–160) | 130 (68–238) |
Ferritin, mg/mL | 569 (264–1115) | 497 (234–924) | 758 (365–1425) |
Troponin, µg/L | 0.015 (0.015–0.043) | 0.015 (0.015–0.066) | 0.015 (0.015–0.026) |
NT-proBNP, ng/L | 350 (92–2076) | 399 (91–2915) | 302.5 (92–781) |
Arterial blood gas analysis at admission | |||
pH | 7.46 (7.42–7.49) | 7.45 (7.42–7.49) | 7.46 (7.43–7.49) |
PaO2, mmHg | 67 (58–80) | 70 (61–83) | 60 (52–73) |
PaO2/FiO2 ratio | 285 (203–340) | 304.5 (232–357) | 246 (150–294) |
Outcomes | |||
Mechanical ventilation (IOT) | 45/483 (9.26%) | 10/330 (3.03%) | 35/153 (22.88%) |
Intra-hospital mortality | 185/483 (38.07%) | 123/330 (37.5274%) | 60/153 (39.22%) |
C-PAP failure | 70/483 (14.40%) | 0/330 (0%) | 70/153 (45.75%) |
Hospital readmission within 30 days from discharge | 40/483 (8.23%) | 25/330 (7.58%) | 15/153 (9.80%) |
Length of hospital stay, days | 13.99 (3.98–23.14) | 12.14 (1.95–22.05) | 17.65 (11.14–24.04) |
Time 0 | Group A | Group B | ||||
---|---|---|---|---|---|---|
At least one adverse outcome | No | Yes | No | Yes | No | Yes |
SatO2 < 94% | 59 | 113 | 18 | 75 | 1 | 34 |
SatO2 ≥ 94% | 158 | 153 | 49 | 58 | 36 | 64 |
p-value | 0.000 | 0.000 | 0.000 |
Time 0 | Group A | Group B | ||||
---|---|---|---|---|---|---|
At least one adverse outcome | No | Yes | No | Yes | No | Yes |
PaO2/FiO2 < 100 | 7 | 30 | 12 | 60 | 2 | 41 |
PaO2/FiO2 100–200 | 20 | 59 | 30 | 68 | 23 | 44 |
PaO2/FiO2 200–300 | 65 | 96 | 17 | 14 | 6 | 14 |
PaO2/FiO2 > 300 | 125 | 81 | 10 | 6 | 6 | 4 |
p-value | 0.000 | 0.000 | 0.000 |
Time 0 | Group A | Group B | ||||||||
---|---|---|---|---|---|---|---|---|---|---|
pO2 | Best pO2 | Worst pO2 | Best pO2 | Worst pO2 | ||||||
At least one adverse outcome | No | Yes | No | Yes | No | Yes | No | Yes | No | Yes |
pO2 < 60 mmHg | 43 | 100 | 2 | 27 | 23 | 84 | 0 | 6 | 3 | 38 |
pO2 60–100 mmHg | 158 | 137 | 35 | 60 | 41 | 42 | 4 | 24 | 19 | 35 |
pO2 > 100 mmHg | 16 | 29 | 29 | 47 | 3 | 8 | 32 | 68 | 14 | 25 |
p-value | 0.000 | 0.005 | 0.000 | 0.055 | 0.003 |
At Least One Adverse Outcome | In-Hospital Mortality | |||
---|---|---|---|---|
OR (95% CI) | p-Value | OR (95% CI) | p-Value | |
SatO2 < 94% | ||||
at Time 0 | 1.98 (1.34–2.91) | 0.001 | 2.12 (1.45–3.11) | 0.000 |
in Group A | 3.52 (1.86–6.67) | 0.000 | 4.10 (2.25–7.47) | 0.000 |
in Group B | 19.12 (2.51–145.63) | 0.004 | 10.12 (4.08–25.14) | 0.000 |
PaO2/FiO2 at Time 0 | ||||
<100 vs. ≥100 | 3.81 (1.64–8.86) | 0.002 | 3.33 (1.65–6.72) | 0.001 |
<200 vs. ≥200 | 3.54 (2.19–5.70) | 0.000 | 3.10 (2.02–4.77) | 0.000 |
<300 vs. ≥300 | 3.10 (2.13–4.51) | 0.000 | 3.40 (2.27–5.10) | 0.000 |
PaO2/FiO2 in Group A | ||||
<100 vs. ≥100 | 3.24 (1.60–6.55) | 0.001 | 3.38 (1.88–6.09) | 0.000 |
<200 vs. ≥200 | 4.11 (2.09–8.08) | 0.000 | 2.47 (1.20–5.09) | 0.014 |
<300 vs. ≥300 | 4.01 (1.39–11.54) | 0.010 | 1.61 (0.54–4.81) | 0.392 |
PaO2/FiO2 in Group B | ||||
<100 vs. ≥100 | 11.57 (2.64–50.76) | 0.001 | 11.94 (5.07–28.13) | 0.000 |
<200 vs. ≥200 | 2.27 (0.96–5.33) | 0.061 | 12.55 (2.85–55.28) | 0.001 |
<300 vs. ≥300 | 4.79 (1.27–18.07) | 0.021 | ** | |
PaO2 < 60 or PaO2 > 100 | ||||
at Time 0 | 2.52 (1.72–3.70) | 0.000 | 2.59 (1.77–3.79) | 0.000 |
Worst in Group A | 3.45 (1.87–6.37) | 0.000 | 3.37 (1.81–6.26) | 0.000 |
Best in Group A | 1.39 (0.77–2.51) | 0.272 | 1.13 (0.64–1.99) | 0.671 |
Worst in Group B | 2.01 (0.93–4.36) | 0.077 | 3.72 (1.68–8.23) | 0.001 |
Best in Group B | 0.38 (0.12–1.20) | 0.100 | 0.41 (0.17–0.95) | 0.039 |
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Sartini, S.; Massobrio, L.; Cutuli, O.; Campodonico, P.; Bernini, C.; Sartini, M.; Cristina, M.L.; Castellani, L.; Ceschi, L.; Spadaro, M.; et al. Role of SatO2, PaO2/FiO2 Ratio and PaO2 to Predict Adverse Outcome in COVID-19: A Retrospective, Cohort Study. Int. J. Environ. Res. Public Health 2021, 18, 11534. https://doi.org/10.3390/ijerph182111534
Sartini S, Massobrio L, Cutuli O, Campodonico P, Bernini C, Sartini M, Cristina ML, Castellani L, Ceschi L, Spadaro M, et al. Role of SatO2, PaO2/FiO2 Ratio and PaO2 to Predict Adverse Outcome in COVID-19: A Retrospective, Cohort Study. International Journal of Environmental Research and Public Health. 2021; 18(21):11534. https://doi.org/10.3390/ijerph182111534
Chicago/Turabian StyleSartini, Stefano, Laura Massobrio, Ombretta Cutuli, Paola Campodonico, Cristina Bernini, Marina Sartini, Maria Luisa Cristina, Luca Castellani, Ludovica Ceschi, Marzia Spadaro, and et al. 2021. "Role of SatO2, PaO2/FiO2 Ratio and PaO2 to Predict Adverse Outcome in COVID-19: A Retrospective, Cohort Study" International Journal of Environmental Research and Public Health 18, no. 21: 11534. https://doi.org/10.3390/ijerph182111534