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: Acute respiratory distress syndrome; COVID-19; Mechanical ventilation; Pulse oximetry; Resource limited settings; SpO(2)/FiO(2).