Role of PAO2/FIO2 Ratio at Admission as Predictors of Respiratory Failure in Covid-19 Patients
Abstract
Abstract
Introduction: The early identification of factors that predict respiratory failure in patients affected by coronavirus disease (COVID-19) will assist therapeutic decisions and patient flow management.
Methodology: We collected, at the time of admission, routine clinical, laboratory, and imaging parameters of hypoxia, lung damage, inflammation, and organ dysfunction in a consecutive series of 60 COVID-19 patients admitted to ESICMC-PGIMSR hospital Rajajinagar.
Results: Patients were divided into mild, moderate and severe ARDS based on Pao2/Fio2 ratio at admission (berlin criteria). The requirement of CPAP, mechanical ventilator, duration of hospital stay and death was compared in the 3 group of patients. Out of 60 patients 25patients had pao2/fio2 ratio <300-200 mm Hg (mild), 18 had 200-100 mm Hg (moderate) and 17 of them had <100 mm Hg (severe). Those patients with lower PaO2/FiO2 ratio at admission were significantly needed the assistance of CPAP, Mechanical ventilator for their hypoxia management, they also had prolonged hospital stay (PHS, >21 days) than patients with higher Pao2/Fio2 ratio. Patients in lower PaO2/FiO2 ratio i.e. in severe group had high mortality rate.
Conclusions: The PaO2/FiO2 ratio on admission is independently associated with significant mortality and morbidity in COVID-19 patients. Larger prospective studies are needed to confirm this finding.
Key word: Covid-19, ARDS, Pao2/Fio2 ratio.
Full text article
References
1. Marco Cascella; Michael Rajnik;et al, Features, Evaluation, and Treatment of Coronavirus (COVID-19)
2. Borczuk AC, Salvatore SP. COVID-19 pulmonary pathology: a multi-institutional autopsy cohort from Italy and New York City. Mod Pathol. 2020 Nov;33(11):2156-2168
3. Huang C, Wang Y et al (2020) Clinical features of patients infected with 2019 novel coronavirus in Wuhan, China. Lancet 395: 497–506.
4. Wang D, Hu B, Hu C,et al (2020) Clinical characteristics of 138 hospitalized patients with 2019 novel coronavirus-infected pneumonia in Wuhan, China. JAMA 323: 1061–1069.
5. Chen N, Zhou M, at al, (2020) Epidemiological and clinical characteristics of 99 cases of 2019 novel coronavirus pneumonia in Wuhan, China: a descriptive study. Lancet 395: 507–513.
6. Liu X, Zhou H, (2020) Risk factors associated with disease severity and length of hospital stay in COVID-19 patients. J Infect 81: E95-E97.
7. Vaira LA, Deiana G,at al (2020) Objective evaluation of anosmia and ageusia in COVID-19 patients: Single-center experience on 72 cases. Head Neck 42: 1252–1258.
8. Long, B.; Brady, W.J.; Koyfman, A.; Gottlieb, M. Cardiovascular complications in COVID-19. Am. J. Emerg. Med. 2020, 38,1504–1507.
9. Force, A.D.T.; Ranieri, V.M.; Rubenfeld, G.D.; Thompson, B.T.; Ferguson, N.; Caldwell, E.; Fan, E.; Camporota, L.; Slutsky, A.S.Acute respiratory distress syndrome. JAMA 2012, 307, 2526–2533.
10. Casas, A.I.; Geuss, E.; Kleikers, P.W.M.; Mencl, S.; Herrmann, A.M.; Buendia, I.; Egea, J.; Meuth, S.G.; Lopez, M.G.; Kleinschnitz, C.; et al. NOX4-dependent neuronal autotoxicity and BBB breakdown explain the superior sensitivity of the brain to ischemic damage. Proc. Natl. Acad. Sci. USA 2017, 114, 12315–12320.
11. Covelli HD, Nessan VJ, Tuttle WK 3rd (1983) Oxygen derived variables in acute respiratory failure. Crit Care Med 11: 646-649.
12. Horovitz JH, Carrico CJ, Shires GT (1974) Pulmonary response to major injury. Arch Surg 108: 349-355.
13. Bernard GR, Artigas A, Brigham KL, Carlet J, Falke K, Hudson L, Lamy M, Legall JR, Morris A, Spragg R (1994) The American-European Consensus Conference on ARDS. Definitions, mechanisms, relevant outcomes, and clinical trial coordination. Am J Respir Crit Care Med 149: 818-824.
14. ARDS Definition Task Force, Ranieri VM, Rubenfeld GD, Thompson BT, Ferguson ND, Caldwell E, Fan E, Camporota L, Slutsky AS (2012) Acute respiratory distress syndrome: the Berlin Definition. JAMA 307: 2526-2533.
15. Kapadohos T, Angelopoulos E, Vasileiadis I, Nanas S, Kotanidou A, Karabinis A, Marathias K, Routsi C (2017) Determinants of prolonged intensive care unit stay in patients after cardiac surgery: a prospective observational study. J Thorac Dis 9: 70-79.
16. Liu Y, Zheng J, Zhang D, Jing L (2019) Neutrophil-lymphocyte ratio and plasma lactate predict 28-day mortality in patients with sepsis. J Clin Lab Anal 33: e22942.
17. Novel Coronavirus Pneumonia Emergency Response Epidemiology Team (2020) The epidemiological characteristics of an outbreak of 2019 novel coronavirus diseases (COVID-19) in China. Zhonghua Liu Xing Bing Xue Za Zhi 41: 145-151.
18. Angelo Zinellu, Andrea De Vito et al, The PaO2/FiO2 ratio on admission is independently associated with prolonged hospitalization in COVID-19 patients.