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Bastidas-Goyes AR, Tuta-Quintero E, Aguilar MF, Mora AV, Aponte HC, Villamizar JM, Galeano S, Mejia P, Muñoz M, Paredes S, Pumarejo D, Barragan MDM. Performance of oxygenation indices and risk scores to predict invasive mechanical ventilation and mortality in COVID-19. BMC Pulm Med 2024; 24:68. [PMID: 38308270 PMCID: PMC10835882 DOI: 10.1186/s12890-023-02807-8] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/08/2023] [Accepted: 12/07/2023] [Indexed: 02/04/2024] Open
Abstract
BACKGROUND Information on the performance of oxygenation indices (OIs) and risk scores in patients requiring invasive mechanical ventilation (IMV) is limited. We determine the performance of the OIs and risk scores in hospitalized patients with COVID-19 to predict the requirement of IMV and death at 28 days after admission. METHODS A retrospective study of diagnostic tests in patients admitted to the emergency department, hospitalization, and intensive care unit diagnosed with COVID-19. The receiver operating characteristic curve (ROC-curve) were built with the OIs and risk scores to predict IMV and mortality. RESULTS A total of 1402 subjects entered the final analysis, of whom 19.5% (274/1402) received IMV and 23.0% (323/1402) died at 28 days. The ROC-curve of the delta PaO2/FiO2 ratio for the requirement of IMV and mortality at 28-day was 0.589 (95% CI: 0.546-0.632) and 0.567 (95% CI: 0.526-0.608), respectively. PaO2/FiO2 ≤ 300 shows a ROC curve of 0.669 (95% CI: 0.628-0.711) to predict IMV. PaO2/FiO2 ≤ 300 and 4 C mortality score in mortality at 28 days showed an ROC-curve of 0.624 (95% CI: 0.582-0.667) and 0.706 (95% CI: 0.669-0.742), respectively. CONCLUSION PaO2/FiO2 ≤ 300, 4 C mortality score ≥ 8, SOFA score ≥ 4 y SaO2/FiO2 ≤ 300 were weak predictors of the IMV requirement from admission, and 4 C mortality score ≥ 8 was weak predictors of the mortality from admission in patients with pulmonary involvement by COVID-19.
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Affiliation(s)
- Alirio R Bastidas-Goyes
- School of Medicine, Internal Medicine Department, Universidad de La Sabana, Km 7, Northern highway. Chía, Chía, Cundinamarca 140013, Colombia.
| | - Eduardo Tuta-Quintero
- School of Medicine, Internal Medicine Department, Universidad de La Sabana, Km 7, Northern highway. Chía, Chía, Cundinamarca 140013, Colombia
| | - Maria F Aguilar
- School of Medicine, Internal Medicine Department, Universidad de La Sabana, Km 7, Northern highway. Chía, Chía, Cundinamarca 140013, Colombia
| | - Angélica V Mora
- School of Medicine, Internal Medicine Department, Universidad de La Sabana, Km 7, Northern highway. Chía, Chía, Cundinamarca 140013, Colombia
| | | | - Jesus M Villamizar
- School of Medicine, Internal Medicine Department, Universidad de La Sabana, Km 7, Northern highway. Chía, Chía, Cundinamarca 140013, Colombia
| | - Susana Galeano
- School of Medicine, Internal Medicine Department, Universidad de La Sabana, Km 7, Northern highway. Chía, Chía, Cundinamarca 140013, Colombia
| | - Paola Mejia
- School of Medicine, Internal Medicine Department, Universidad de La Sabana, Km 7, Northern highway. Chía, Chía, Cundinamarca 140013, Colombia
| | - Maria Muñoz
- School of Medicine, Internal Medicine Department, Universidad de La Sabana, Km 7, Northern highway. Chía, Chía, Cundinamarca 140013, Colombia
| | - Sara Paredes
- School of Medicine, Internal Medicine Department, Universidad de La Sabana, Km 7, Northern highway. Chía, Chía, Cundinamarca 140013, Colombia
| | - Doris Pumarejo
- School of Medicine, Internal Medicine Department, Universidad de La Sabana, Km 7, Northern highway. Chía, Chía, Cundinamarca 140013, Colombia
| | - Maria Del Mar Barragan
- School of Medicine, Internal Medicine Department, Universidad de La Sabana, Km 7, Northern highway. Chía, Chía, Cundinamarca 140013, Colombia
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Sánchez Díaz JS, Peniche Moguel KG, Reyes-Ruiz JM, Pérez Nieto OR, Escarramán Martínez D, Zamarrón López EI, Calyeca Sánchez MV. The ∆Pv-aCO2/∆Ca-vO2 ratio as a predictor of mortality in patients with severe acute respiratory distress syndrome related to COVID-19. PLoS One 2023; 18:e0290272. [PMID: 37672537 PMCID: PMC10482256 DOI: 10.1371/journal.pone.0290272] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/20/2022] [Accepted: 08/05/2023] [Indexed: 09/08/2023] Open
Abstract
OBJECTIVE To evaluate the central venous-to-arterial carbon dioxide difference combined with arterial-to-venous oxygen content difference (∆Pv-aCO2/∆Ca-vO2 ratio) as a predictor of mortality in patients with COVID-19-related severe acute respiratory distress syndrome (ARDS). METHODS Patients admitted to the intensive care unit with severe ARDS secondary to SARS-CoV-2, and invasive mechanical ventilation were included in this single-center and retrospective cohort study performed between April 18, 2020, and January 18, 2022. The tissue perfusion indexes (lactate, central venous oxygen saturation [ScvO2], and venous-to-arterial carbon dioxide pressure difference [∆Pv-aCO2]), anaerobic metabolism index (∆Pv-aCO2/∆Ca-vO2 ratio), and severity index (Simplified Acute Physiology Score II [SAPSII]) were evaluated to determine its association with the mortality through Cox regression analysis, Kaplan-Meier curve and receiver operating characteristic (ROC) curve. RESULTS One hundred fifteen patients were included in the study and classified into two groups, the survivor group (n = 54) and the non-survivor group (n = 61). The lactate, ScvO2, ∆Pv-aCO2, and ∆Pv-aCO2/∆Ca-vO2 ratio medians were 1.6 mEq/L, 75%, 5 mmHg, and 1.56 mmHg/mL, respectively. The ∆Pv-aCO2/∆Ca-vO2 ratio (Hazard Ratio (HR) = 1.17, 95% confidence interval (CI) = 1.06-1.29, p = 0.001) was identified as a mortality biomarker for patients with COVID-19-related severe ARDS. The area under the curve for ∆Pv-aCO2/∆Ca-vO2 ratio was 0.691 (95% CI 0.598-0.774, p = 0.0001). The best cut-off point for ∆Pv-aCO2/∆Ca-vO2 ratio was >2.14 mmHg/mL, with a sensitivity of 49.18%, specificity of 85.19%, a positive likelihood of 3.32, and a negative likelihood of 0.6. The Kaplan-Meier curve showed that survival rates were significantly worse in patients with values greater than this cut-off point. CONCLUSIONS The ∆Pv-aCO2/∆Ca-vO2 ratio could be used as a predictor of mortality in patients with severe ARDS secondary to SARS-CoV-2.
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Affiliation(s)
- Jesús Salvador Sánchez Díaz
- Critical Care Department, Unidad Médica de Alta Especialidad, Hospital de Especialidades No. 14, Centro Médico Nacional “Adolfo Ruiz Cortines”, Instituto Mexicano del Seguro Social (IMSS), Veracruz, Mexico
| | - Karla Gabriela Peniche Moguel
- Critical Care Department, Unidad Médica de Alta Especialidad, Hospital de Especialidades No. 14, Centro Médico Nacional “Adolfo Ruiz Cortines”, Instituto Mexicano del Seguro Social (IMSS), Veracruz, Mexico
| | - José Manuel Reyes-Ruiz
- Department of Health Research, Unidad Médica de Alta Especialidad, Hospital de Especialidades No. 14, Centro Médico Nacional “Adolfo Ruiz Cortines”, Instituto Mexicano del Seguro Social (IMSS), Veracruz, Mexico
| | | | - Diego Escarramán Martínez
- Department of Anesthesiology, Centro Médico Nacional "La Raza", Instituto Mexicano del Seguro Social (IMSS), Mexico City, Mexico
| | - Eder Iván Zamarrón López
- Critical Care Department, Hospital General Regional No. 6, Instituto Mexicano del Seguro Social (IMSS), Ciudad Madero, Tamaulipas, Mexico
| | - María Verónica Calyeca Sánchez
- Critical Care Department, Unidad Médica de Alta Especialidad, Hospital de Especialidades No. 14, Centro Médico Nacional “Adolfo Ruiz Cortines”, Instituto Mexicano del Seguro Social (IMSS), Veracruz, Mexico
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Shi L, Wang Y, Han X, Wang Y, Xu J, Yang H. Comorbid asthma decreased the risk for COVID-19 mortality in the United Kingdom: Evidence based on a meta-analysis. Int Immunopharmacol 2023; 120:110365. [PMID: 37224652 DOI: 10.1016/j.intimp.2023.110365] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/22/2023] [Revised: 05/15/2023] [Accepted: 05/18/2023] [Indexed: 05/26/2023]
Abstract
The study aimed to investigate the influence of comorbid asthma on the risk for mortality among patients with coronavirus disease 2019 (COVID-19) in the United Kingdom (UK) by utilizing a quantitative meta-analysis. The pooled odds ratio (OR) with 95% confidence interval (CI) was estimated by conducting a random-effects model. Sensitivity analysis, I2 statistic, meta-regression, subgroup analysis, Begg's analysis and Egger's analysis were all implemented. Our results presented that comorbid asthma was significantly related to a decreased risk for COVID-19 mortality in the UK based on 24 eligible studies with 1,209,675 COVID-19 patients (pooled OR = 0.81, 95% CI: 0.71-0.93; I2 = 89.2%, P < 0.01). Coming through further meta-regression to seek the possible cause of heterogeneity, none of elements might be responsible for heterogeneity. A sensitivity analysis proved the stability and reliability of the overall results. Both Begg's analysis (P = 1.000) and Egger's analysis (P = 0.271) manifested that publication bias did not exist. In conclusion, our data demonstrated that COVID-19 patients with comorbid asthma might bear a lower risk for mortality in the UK. Furthermore, routine intervention and treatment of asthma patients with severe acute respiratory syndrome coronavirus 2 infection should be continued in the UK.
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Affiliation(s)
- Liqin Shi
- Department of Epidemiology, School of Public Health, Zhengzhou University, Zhengzhou, 450001 Henan Province, China
| | - Yadong Wang
- Department of Toxicology, Henan Center for Disease Control and Prevention, Zhengzhou, 450016, Henan Province, China
| | - Xueya Han
- Department of Epidemiology, School of Public Health, Zhengzhou University, Zhengzhou, 450001 Henan Province, China
| | - Ying Wang
- Department of Epidemiology, School of Public Health, Zhengzhou University, Zhengzhou, 450001 Henan Province, China
| | - Jie Xu
- Department of Epidemiology, School of Public Health, Zhengzhou University, Zhengzhou, 450001 Henan Province, China
| | - Haiyan Yang
- Department of Epidemiology, School of Public Health, Zhengzhou University, Zhengzhou, 450001 Henan Province, China.
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