Predictive value of oxygenation index at intensive care unit admission for 30-day mortality in patients with sepsis.
10.3760/cma.j.cn121430-20240327-00292
- Author:
Chunhua BI
1
;
Manchen ZHU
2
;
Chen NI
3
;
Zongfeng ZHANG
2
;
Zhiling QI
2
;
Huanhuan CHENG
4
,
5
;
Zongqiang LI
2
;
Cuiping HAO
2
Author Information
1. Comprehensive Medical Training Center, Jining Medical University, Jining 272067, Shandong, China.
2. Department of Critical Care Medicine, Affiliated Hospital of Jining Medical University, Jining 272030, Shandong, China.
3. Clinical College of Jining Medical University, Jining 272067, Shandong, China.
4. School of Nursing, Shandong University of Traditional Chinese Medicine, Jinan 250355, Shandong, China. Corresponding author: Hao Cuiping, Email: hcuiping0709@
5. com.
- Publication Type:Journal Article
- MeSH:
Humans;
Sepsis/mortality*;
Intensive Care Units;
Retrospective Studies;
Prognosis;
Hospital Mortality;
Oxygen;
Male;
Predictive Value of Tests;
Female;
Middle Aged;
Aged
- From:
Chinese Critical Care Medicine
2025;37(2):111-117
- CountryChina
- Language:Chinese
-
Abstract:
OBJECTIVE:To investigate the predictive value of oxygenation index (PaO2/FiO2) at intensive care unit (ICU) admission on 30-day mortality in patients with sepsis.
METHODS:A retrospective study was conducted. Patients with sepsis who were hospitalized in the ICU of the Affiliated Hospital of Jining Medical University from April 2015 to October 2023 were enrolled. The demographic information, comorbidities, sites of infection, vital signs and laboratory test indicators at the time of admission to the ICU, disease severity scores within 24 hours of admission to the ICU, treatment process and prognostic indicators were collected. According to the PaO2/FiO2 at ICU admission, patients were divided into Q1 group (PaO2/FiO2 of 4.1-16.4 cmHg, 1 cmHg ≈ 1.33 kPa), Q2 group (PaO2/FiO2 of 16.5-22.6 cmHg), Q3 group (PaO2/FiO2 of 22.7-32.9 cmHg), and Q4 group (PaO2/FiO2 of 33.0-94.8 cmHg). Differences in the indicators across the four groups were compared. Multifactorial Cox regression analysis was used to assess the relationship between PaO2/FiO2 and 30-day mortality of patients with sepsis. The predictive value of PaO2/FiO2, sequential organ failure assessment (SOFA) and acute physiology and chronic health evaluation II (APACHE II) on 30-day prognosis of patients with sepsis was analyzed by receiver operator characteristic curve (ROC curve).
RESULTS:A total of 1 711 patients with sepsis were enrolled, including 428 patients in Q1 group, 424 patients in Q2 group, 425 patients in Q3 group, and 434 patients in Q4 group. 622 patients died at 30-day, the overall 30-day mortality was 36.35%. There were statistically significant differences in age, body mass index (BMI), history of smoking, history of alcohol consumption, admission heart rate, respiratory rate, APACHE II score, SOFA score, Glasgow coma score (GCS), site of infection, Combined chronic obstructive pulmonary disease (COPD), blood lactic acid (Lac), prothrombin time (PT), albumin (Alb), total bilirubin (TBil), pH, proportion of mechanical ventilation, duration of mechanical ventilation, proportion of vasoactive medication used, and maximal concentration, length of ICU stay, hospital stay, incidence of acute kidney injury, in-hospital mortality, 30-day mortality among the four groups. Multivariate Cox regression analysis showed that after adjusting for confounding factors, for every 1 cmHg increase in PaO2/FiO2 at ICU admission, the 30-day mortality risk decreased by 2% [hazard ratio (HR) = 0.98, 95% confidence interval (95%CI) was 0.98-0.99, P < 0.001]. The 30-day mortality risk in the Q4 group was reduced compared with the Q1 group by 41% (HR = 0.59, 95%CI was 0.46-0.76, P < 0.001). The fitted curve showed that a curvilinear relationship between PaO2/FiO2 and 30-day mortality after adjustment for confounders. In the inflection point analysis, for every 1 cmHg increase in PaO2/FiO2 at PaO2/FiO2 < 28.55 cmHg, the risk of 30-day death in sepsis patients was reduced by 5% (HR = 0.95, 95%CI was 0.94-0.97, P < 0.001); when PaO2/FiO2 ≥ 28.55 cmHg, there was no statistically significant association between PaO2/FiO2 and the increase in the risk of 30-day death in sepsis (HR = 1.01, 95%CI was 0.99-1.02, P = 0.512). ROC curve analysis showed that the area under the curve (AUC) for the prediction of 30-day mortality by admission PaO2/FiO2 in ICU sepsis patients was 0.650, which was lower than the predictive ability of the SOFA score (AUC = 0.698) and APACHE II score (AUC = 0.723).
CONCLUSION:In patients with sepsis, PaO2/FiO2 at ICU admission is strongly associated with 30-day mortality risk, alerting healthcare professionals to pay attention to patients with low PaO2/FiO2 for timely interventions.
