Prognostication using SpO2/FiO2 in invasively ventilated ICU patients with ARDS due to COVID-19 - Insights from the PRoVENT-COVID study

Jan-Paul Roozeman; Guido Mazzinari; Ary Serpa Neto; Markus W.  Hollmann; Frederique Paulus; Marcus J.  Schultz; Luigi Pisani; PRoVENT-COVID Collaborative Group

doi:10.1016/j.jcrc.2021.11.009

Prognostication using SpO2/FiO2 in invasively ventilated ICU patients with ARDS due to COVID-19 - Insights from the PRoVENT-COVID study

Jan-Paul Roozeman
, Guido Mazzinari
, Ary Serpa Neto
, Markus W. Hollmann
, Frederique Paulus
, Marcus J. Schultz
, Luigi Pisani
, PRoVENT-COVID Collaborative Group

Critical Care

Research output: Contribution to journal › Article › Academic › peer-review

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Abstract

BACKGROUND: The SpO2/FiO2 is a useful oxygenation parameter with prognostic capacity in patients with ARDS. We investigated the prognostic capacity of SpO2/FiO2 for mortality in patients with ARDS due to COVID-19.

METHODS: This was a post-hoc analysis of a national multicenter cohort study in invasively ventilated patients with ARDS due to COVID-19. The primary endpoint was 28-day mortality.

RESULTS: In 869 invasively ventilated patients, 28-day mortality was 30.1%. The SpO2/FiO2 on day 1 had no prognostic value. The SpO2/FiO2 on day 2 and day 3 had prognostic capacity for death, with the best cut-offs being 179 and 199, respectively. Both SpO2/FiO2 on day 2 (OR, 0.66 [95%-CI 0.46-0.96]) and on day 3 (OR, 0.70 [95%-CI 0.51-0.96]) were associated with 28-day mortality in a model corrected for age, pH, lactate levels and kidney dysfunction (AUROC 0.78 [0.76-0.79]). The measured PaO2/FiO2 and the PaO2/FiO2 calculated from SpO2/FiO2 were strongly correlated (Spearman's r = 0.79).

CONCLUSIONS: In this cohort of patients with ARDS due to COVID-19, the SpO2/FiO2 on day 2 and day 3 are independently associated with and have prognostic capacity for 28-day mortality. The SpO2/FiO2 is a useful metric for risk stratification in invasively ventilated COVID-19 patients.

Original language	English
Pages (from-to)	31-37
Journal	Journal of Critical Care
Volume	68
DOIs	https://doi.org/10.1016/j.jcrc.2021.11.009
Publication status	Published - Apr 2022

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@article{474139a694f64e2cbe49a44507f3e780,

title = "Prognostication using SpO2/FiO2 in invasively ventilated ICU patients with ARDS due to COVID-19 - Insights from the PRoVENT-COVID study",

abstract = "BACKGROUND: The SpO2/FiO2 is a useful oxygenation parameter with prognostic capacity in patients with ARDS. We investigated the prognostic capacity of SpO2/FiO2 for mortality in patients with ARDS due to COVID-19.METHODS: This was a post-hoc analysis of a national multicenter cohort study in invasively ventilated patients with ARDS due to COVID-19. The primary endpoint was 28-day mortality.RESULTS: In 869 invasively ventilated patients, 28-day mortality was 30.1\%. The SpO2/FiO2 on day 1 had no prognostic value. The SpO2/FiO2 on day 2 and day 3 had prognostic capacity for death, with the best cut-offs being 179 and 199, respectively. Both SpO2/FiO2 on day 2 (OR, 0.66 [95\%-CI 0.46-0.96]) and on day 3 (OR, 0.70 [95\%-CI 0.51-0.96]) were associated with 28-day mortality in a model corrected for age, pH, lactate levels and kidney dysfunction (AUROC 0.78 [0.76-0.79]). The measured PaO2/FiO2 and the PaO2/FiO2 calculated from SpO2/FiO2 were strongly correlated (Spearman's r = 0.79).CONCLUSIONS: In this cohort of patients with ARDS due to COVID-19, the SpO2/FiO2 on day 2 and day 3 are independently associated with and have prognostic capacity for 28-day mortality. The SpO2/FiO2 is a useful metric for risk stratification in invasively ventilated COVID-19 patients.",

keywords = "COVID-19, Acute respiratory distress syndrome, SpO2/FiO2, Pulse oximetry, Mechanical ventilation, Resource limited settings",

author = "Jan-Paul Roozeman and Guido Mazzinari and \{Serpa Neto\}, Ary and Hollmann, \{Markus W.\} and Frederique Paulus and Schultz, \{Marcus J.\} and Luigi Pisani and \{PRoVENT-COVID Collaborative Group\}",

note = "With supplementary file. ",

year = "2022",

month = apr,

doi = "10.1016/j.jcrc.2021.11.009",

language = "English",

volume = "68",

pages = "31--37",

journal = "Journal of Critical Care",

issn = "0883-9441",

publisher = "W.B. Saunders",

}

TY - JOUR

T1 - Prognostication using SpO2/FiO2 in invasively ventilated ICU patients with ARDS due to COVID-19 - Insights from the PRoVENT-COVID study

AU - Roozeman, Jan-Paul

AU - Mazzinari, Guido

AU - Serpa Neto, Ary

AU - Hollmann, Markus W.

AU - Paulus, Frederique

AU - Schultz, Marcus J.

AU - Pisani, Luigi

AU - PRoVENT-COVID Collaborative Group

N1 - With supplementary file.

PY - 2022/4

Y1 - 2022/4

N2 - BACKGROUND: The SpO2/FiO2 is a useful oxygenation parameter with prognostic capacity in patients with ARDS. We investigated the prognostic capacity of SpO2/FiO2 for mortality in patients with ARDS due to COVID-19.METHODS: This was a post-hoc analysis of a national multicenter cohort study in invasively ventilated patients with ARDS due to COVID-19. The primary endpoint was 28-day mortality.RESULTS: In 869 invasively ventilated patients, 28-day mortality was 30.1%. The SpO2/FiO2 on day 1 had no prognostic value. The SpO2/FiO2 on day 2 and day 3 had prognostic capacity for death, with the best cut-offs being 179 and 199, respectively. Both SpO2/FiO2 on day 2 (OR, 0.66 [95%-CI 0.46-0.96]) and on day 3 (OR, 0.70 [95%-CI 0.51-0.96]) were associated with 28-day mortality in a model corrected for age, pH, lactate levels and kidney dysfunction (AUROC 0.78 [0.76-0.79]). The measured PaO2/FiO2 and the PaO2/FiO2 calculated from SpO2/FiO2 were strongly correlated (Spearman's r = 0.79).CONCLUSIONS: In this cohort of patients with ARDS due to COVID-19, the SpO2/FiO2 on day 2 and day 3 are independently associated with and have prognostic capacity for 28-day mortality. The SpO2/FiO2 is a useful metric for risk stratification in invasively ventilated COVID-19 patients.

AB - BACKGROUND: The SpO2/FiO2 is a useful oxygenation parameter with prognostic capacity in patients with ARDS. We investigated the prognostic capacity of SpO2/FiO2 for mortality in patients with ARDS due to COVID-19.METHODS: This was a post-hoc analysis of a national multicenter cohort study in invasively ventilated patients with ARDS due to COVID-19. The primary endpoint was 28-day mortality.RESULTS: In 869 invasively ventilated patients, 28-day mortality was 30.1%. The SpO2/FiO2 on day 1 had no prognostic value. The SpO2/FiO2 on day 2 and day 3 had prognostic capacity for death, with the best cut-offs being 179 and 199, respectively. Both SpO2/FiO2 on day 2 (OR, 0.66 [95%-CI 0.46-0.96]) and on day 3 (OR, 0.70 [95%-CI 0.51-0.96]) were associated with 28-day mortality in a model corrected for age, pH, lactate levels and kidney dysfunction (AUROC 0.78 [0.76-0.79]). The measured PaO2/FiO2 and the PaO2/FiO2 calculated from SpO2/FiO2 were strongly correlated (Spearman's r = 0.79).CONCLUSIONS: In this cohort of patients with ARDS due to COVID-19, the SpO2/FiO2 on day 2 and day 3 are independently associated with and have prognostic capacity for 28-day mortality. The SpO2/FiO2 is a useful metric for risk stratification in invasively ventilated COVID-19 patients.

KW - COVID-19

KW - Acute respiratory distress syndrome

KW - SpO2/FiO2

KW - Pulse oximetry

KW - Mechanical ventilation

KW - Resource limited settings

UR - https://www.scopus.com/pages/publications/85126317579

U2 - 10.1016/j.jcrc.2021.11.009

DO - 10.1016/j.jcrc.2021.11.009

M3 - Article

C2 - 34872014

SN - 0883-9441

VL - 68

SP - 31

EP - 37

JO - Journal of Critical Care

JF - Journal of Critical Care

ER -

Prognostication using SpO2/FiO2 in invasively ventilated ICU patients with ARDS due to COVID-19 - Insights from the PRoVENT-COVID study

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