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, Anna Geke Algera, L.S. Boers, Lieuwe D. J. Bos, Michela Botta, Dave A. Dongelmans, Markus W. Hollmann, Janneke Horn, Frederique Paulus, Janesh Pillay, Marcus J. Schultz, Ary Serpa Neto, Anissa M. Tsonas, Alexander P. J. Vlaar, Michela Botta, Anissa M. Tsonas, Sanchit Ahuja, J.P. van Akkeren, Anna Geke Algera, C.K. Algoe, Rombout B. E. van Amstel, Antonio Artigas, O Baur, P. van de Berg, A.E. van den Berg, D. C. J. J. Bergmans, D.I. van den Bersselaar, F.A. Bertens, Alexander J. G. H. Bindels, M.M. de Boer, Sylvia den Boer, L.S. Boers, Margriet Bogerd, Lieuwe D. J. Bos, Michela Botta, Jennifer S. Breel, H. de Bruin, Sanne de Bruin, C.L. Bruna, Laura A. Buiteman‐Kruizinga, Olaf L. Cremer, R.M. Determann, Willem Dieperink, Dave A. Dongelmans, H.S. Franke, Michał S. Gałek-Aldridge, Mart J. de Graaff, Laura A. Hagens, Jasper J. Haringman, S.T. van der Heide, Pim L. J. van der Heiden, Nanon F. L. Heijnen, S.J.P. Hiel, Lotte Hoeijmakers, Liselotte Hol, Markus W. Hollmann, Marga Hoogendoorn, Janneke Horn, R. van der Horst, E.L.K. Ie, D. Ivanov, Nicole P. Juffermans, Eline Kho, Eline S. de Klerk, A.W.M.M. Koopman-van Gemert, Matty Koopmans, Songul Kucukcelebi, Michaël Kuiper, Dylan W. de Lange, Niels van Mourik, Sunny G. L. H. Nijbroek, Marisa Onrust, Evelien Oostdijk, Frederique Paulus, C.J. Pennartz, Janesh Pillay, Luigi Pisani, Ilse M. Purmer, Thijs C. D. Rettig, Jan-Paul Roozeman, M.T.U. Schuijt, Marcus J. Schultz, Ary Serpa Neto, M. E. Sleeswijk, Marry R. Smit, Peter E. Spronk, Willemke Stilma, Aart C. Strang, Anissa M. Tsonas, Pieter R. Tuinman, Christel M. A. Valk, F.L. Veen-Schra, Lars I. Veldhuis, Patricia van Velzen
Abstract
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. 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. 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). 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.