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

Roozeman, J. -P.; Mazzinari, G.; Serpa Neto, A.; Hollmann, M. W.; Paulus, F.; Schultz, M. J.; Pisani, L.; Algera, A. G.; Boers, L. S.; Bos, L. D. J.; Botta, M.; Dongelmans, D. A.; Hollmann, M. W.; Horn, J.; Paulus, F.; Pillay, J.; Tsonas, A. M.; Vlaar, A. P. J.; Ahuja, S.; van Akkeren, J. P.; Algoe, C. K.; van Amstel, R. B.; Artigas, A.; Baur, O. L.; van de Berg, P.; van den Berg, A. E.; Bergmans, D. C. J. J.; van den Bersselaar, D. I.; Bertens, F. A.; Bindels, A. J. G. H.; de Boer, M. M.; den Boer, S.; Bogerd, M.; Breel, J. S.; de Bruin, H.; de Bruin, S.; Bruna, C. L.; Buiteman-Kruizinga, L. A.; Cremer, O. L.; Determann, R. M.; Dieperink, W.; Franke, H. S.; Galek-Aldridge, M. S.; de Graaff, M. J.; Hagens, L. A.; Haringman, J. J.; van der Heide, S. T.; van der Heiden, P. L. J.; Heijnen, N. F. L.; Hiel, S. J. P.; Hoeijmakers, L. L.; Hol, L.; Hoogendoorn, M. E.; van der Horst, R.; E. L. K., Ie; Ivanov, D.; Juffermans, N. P.; Kho, E.; de Klerk, E. S.; Gemert, A. W. M. M. K. -V.; Koopmans, M.; Kucukcelebi, S.; Kuiper, M. A.; de Lange, D. W.; van Mourik, N.; Nijbroek, S. G.; Onrust, M.; Oostdijk, E. A. N.; Pennartz, C. J.; Pisani, L.; Purmer, I. M.; Rettig, T. C. D.; Roozeman, J. P.; Schuijt, M. T. U.; Sleeswijk, M. E.; Smit, M. R.; Spronk, P. E.; Stilma, W.; Strang, A. C.; Tuinman, P. R.; Valk, C. M. A.; Veen-Schra, F. L.; Veldhuis, L. I.; van Velzen, P.; van der Ven, W. H.; van Vliet, P.; van der Voort, P. H. J.; van Welie, L.; Wesselink, H. J. F. T.; van der Wier-Lubbers, H. H.; van Wijk, B.; Winters, T.; Wong, W. Y.; van Zanten, A. R. H.

doi:10.1016/j.jcrc.2021.11.009

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.