SpO<inf>2</inf>/FiO<inf>2</inf> ratio on hospital admission is an indicator of early acute respiratory distress syndrome development among patients at risk

Emir Festic; Vikas Bansal; Daryl J Kor; Ognjen Gajic

doi:10.1177/0885066613516411

SpO<inf>2</inf>/FiO<inf>2</inf> ratio on hospital admission is an indicator of early acute respiratory distress syndrome development among patients at risk

Emir Festic, Vikas Bansal, Daryl J Kor, Ognjen Gajic

Research output: Contribution to journal › Article › peer-review

19 Scopus citations

Abstract

Purpose: Oxygen saturation to fraction of inspired oxygen ratio (SpO<inf>2</inf>/FiO<inf>2</inf>) has been validated as a surrogate marker for partial pressure of oxygen to fraction of inspired oxygen ratio among mechanically ventilated patients with acute respiratory distress syndrome (ARDS). The validity of SpO<inf>2</inf>/FiO<inf>2</inf> measurements in predicting ARDS has not been studied. Recently, a Lung Injury Prediction Score (LIPS) has been developed to help identify patients at risk of developing ARDS. Methods: This was a secondary analysis of the LIPS-1 cohort. A multivariate logistic regression included all established variables for LIPS, Acute Physiology and Chronic Health Evaluation 2, age, and comorbid conditions that could affect SpO<inf>2</inf>/FiO<inf>2</inf>. The primary outcome was development of ARDS in the hospital. The secondary outcomes included hospital mortality, hospital day of ARDS development, and hospital day of death. Results: Of the 5584 patients, we evaluated all 4646 with recorded SpO<inf>2</inf>/FiO<inf>2</inf> values. Median SpO<inf>2</inf>/FiO<inf>2</inf> in those who did and did not develop ARDS was 254 (100, 438) and 452 (329, 467), respectively. There was a significant association between SpO<inf>2</inf>/FiO<inf>2</inf> and ARDS (P <.001). The SpO<inf>2</inf>/FiO<inf>2</inf> was found to be an independent predictor of ARDS in a ''dosedependent'' manner; for SpO<inf>2</inf>/FiO<inf>2</inf> < 100-odds ratios (OR) 2.49 (1.69-3.64, P < .001), for SpO<inf>2</inf>/FiO<inf>2</inf> 100 < 200-OR 1.75 (1.16-2.58, P = .007), and for SpO<inf>2</inf>/FiO<inf>2</inf> 200 300-OR 1.62 (1.06-2.42, P = .025). The discriminatory characteristics of the multivariable model and SpO<inf>2</inf>/FiO<inf>2</inf> as a single variable demonstrated area under the curve (AUC) of 0.81 and AUC of 0.74, respectively. Conclusions: The SpO<inf>2</inf>/FiO<inf>2</inf>, measured within the first 6 hours after hospital admission, is an independent indicator of ARDS development among patients at risk.

Original language	English (US)
Pages (from-to)	209-216
Number of pages	8
Journal	Journal of Intensive Care Medicine
Volume	30
Issue number	4
DOIs	https://doi.org/10.1177/0885066613516411
State	Published - May 8 2015

Keywords

admission
ARDS
oxygenation
prediction

ASJC Scopus subject areas

Critical Care and Intensive Care Medicine

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@article{fb643937383a4e1c8a07be9a5229adbf,

title = "SpO2/FiO2 ratio on hospital admission is an indicator of early acute respiratory distress syndrome development among patients at risk",

abstract = "Purpose: Oxygen saturation to fraction of inspired oxygen ratio (SpO2/FiO2) has been validated as a surrogate marker for partial pressure of oxygen to fraction of inspired oxygen ratio among mechanically ventilated patients with acute respiratory distress syndrome (ARDS). The validity of SpO2/FiO2 measurements in predicting ARDS has not been studied. Recently, a Lung Injury Prediction Score (LIPS) has been developed to help identify patients at risk of developing ARDS. Methods: This was a secondary analysis of the LIPS-1 cohort. A multivariate logistic regression included all established variables for LIPS, Acute Physiology and Chronic Health Evaluation 2, age, and comorbid conditions that could affect SpO2/FiO2. The primary outcome was development of ARDS in the hospital. The secondary outcomes included hospital mortality, hospital day of ARDS development, and hospital day of death. Results: Of the 5584 patients, we evaluated all 4646 with recorded SpO2/FiO2 values. Median SpO2/FiO2 in those who did and did not develop ARDS was 254 (100, 438) and 452 (329, 467), respectively. There was a significant association between SpO2/FiO2 and ARDS (P <.001). The SpO2/FiO2 was found to be an independent predictor of ARDS in a ''dosedependent'' manner; for SpO2/FiO2 < 100-odds ratios (OR) 2.49 (1.69-3.64, P < .001), for SpO2/FiO2 100 < 200-OR 1.75 (1.16-2.58, P = .007), and for SpO2/FiO2 200 300-OR 1.62 (1.06-2.42, P = .025). The discriminatory characteristics of the multivariable model and SpO2/FiO2 as a single variable demonstrated area under the curve (AUC) of 0.81 and AUC of 0.74, respectively. Conclusions: The SpO2/FiO2, measured within the first 6 hours after hospital admission, is an independent indicator of ARDS development among patients at risk.",

keywords = "admission, ARDS, oxygenation, prediction",

author = "Emir Festic and Vikas Bansal and Kor, {Daryl J} and Ognjen Gajic",

year = "2015",

month = may,

day = "8",

doi = "10.1177/0885066613516411",

language = "English (US)",

volume = "30",

pages = "209--216",

journal = "Journal of Intensive Care Medicine",

issn = "0885-0666",

publisher = "SAGE Publications Inc.",

number = "4",

}

TY - JOUR

T1 - SpO2/FiO2 ratio on hospital admission is an indicator of early acute respiratory distress syndrome development among patients at risk

AU - Festic, Emir

AU - Bansal, Vikas

AU - Kor, Daryl J

AU - Gajic, Ognjen

PY - 2015/5/8

Y1 - 2015/5/8

N2 - Purpose: Oxygen saturation to fraction of inspired oxygen ratio (SpO2/FiO2) has been validated as a surrogate marker for partial pressure of oxygen to fraction of inspired oxygen ratio among mechanically ventilated patients with acute respiratory distress syndrome (ARDS). The validity of SpO2/FiO2 measurements in predicting ARDS has not been studied. Recently, a Lung Injury Prediction Score (LIPS) has been developed to help identify patients at risk of developing ARDS. Methods: This was a secondary analysis of the LIPS-1 cohort. A multivariate logistic regression included all established variables for LIPS, Acute Physiology and Chronic Health Evaluation 2, age, and comorbid conditions that could affect SpO2/FiO2. The primary outcome was development of ARDS in the hospital. The secondary outcomes included hospital mortality, hospital day of ARDS development, and hospital day of death. Results: Of the 5584 patients, we evaluated all 4646 with recorded SpO2/FiO2 values. Median SpO2/FiO2 in those who did and did not develop ARDS was 254 (100, 438) and 452 (329, 467), respectively. There was a significant association between SpO2/FiO2 and ARDS (P <.001). The SpO2/FiO2 was found to be an independent predictor of ARDS in a ''dosedependent'' manner; for SpO2/FiO2 < 100-odds ratios (OR) 2.49 (1.69-3.64, P < .001), for SpO2/FiO2 100 < 200-OR 1.75 (1.16-2.58, P = .007), and for SpO2/FiO2 200 300-OR 1.62 (1.06-2.42, P = .025). The discriminatory characteristics of the multivariable model and SpO2/FiO2 as a single variable demonstrated area under the curve (AUC) of 0.81 and AUC of 0.74, respectively. Conclusions: The SpO2/FiO2, measured within the first 6 hours after hospital admission, is an independent indicator of ARDS development among patients at risk.

AB - Purpose: Oxygen saturation to fraction of inspired oxygen ratio (SpO2/FiO2) has been validated as a surrogate marker for partial pressure of oxygen to fraction of inspired oxygen ratio among mechanically ventilated patients with acute respiratory distress syndrome (ARDS). The validity of SpO2/FiO2 measurements in predicting ARDS has not been studied. Recently, a Lung Injury Prediction Score (LIPS) has been developed to help identify patients at risk of developing ARDS. Methods: This was a secondary analysis of the LIPS-1 cohort. A multivariate logistic regression included all established variables for LIPS, Acute Physiology and Chronic Health Evaluation 2, age, and comorbid conditions that could affect SpO2/FiO2. The primary outcome was development of ARDS in the hospital. The secondary outcomes included hospital mortality, hospital day of ARDS development, and hospital day of death. Results: Of the 5584 patients, we evaluated all 4646 with recorded SpO2/FiO2 values. Median SpO2/FiO2 in those who did and did not develop ARDS was 254 (100, 438) and 452 (329, 467), respectively. There was a significant association between SpO2/FiO2 and ARDS (P <.001). The SpO2/FiO2 was found to be an independent predictor of ARDS in a ''dosedependent'' manner; for SpO2/FiO2 < 100-odds ratios (OR) 2.49 (1.69-3.64, P < .001), for SpO2/FiO2 100 < 200-OR 1.75 (1.16-2.58, P = .007), and for SpO2/FiO2 200 300-OR 1.62 (1.06-2.42, P = .025). The discriminatory characteristics of the multivariable model and SpO2/FiO2 as a single variable demonstrated area under the curve (AUC) of 0.81 and AUC of 0.74, respectively. Conclusions: The SpO2/FiO2, measured within the first 6 hours after hospital admission, is an independent indicator of ARDS development among patients at risk.

KW - admission

KW - ARDS

KW - oxygenation

KW - prediction

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