Chen Wan-Ling, Lin Wei-Ting, Kung Shu-Chen, Lai Chih-Cheng, Chao Chien-Ming
Department of Respiratory Therapy, Chi Mei Medical Center, Liouying, Tainan 73657, Taiwan.
Departments of Orthopedics and Trauma, Chi Mei Medical Center, Tainan 71004, Taiwan.
J Clin Med. 2018 Aug 8;7(8):205. doi: 10.3390/jcm7080205.
This study aims to investigate the association between oxygenation saturation index (OSI) and the outcome of acute respiratory distress syndrome (ARDS) patients, and assess the predictive performance of OSI for ARDS patients' mortality. This study was conducted at one regional hospital with 66 adult intensive care unit (ICU) beds. All patients with ARDS were identified between November 1 2016 and May 31 2018, and their clinical information was retrospectively collected. The lowest PaO₂/FiO₂ ratio and SpO₂/FiO₂ ratio and highest mean airway pressure (MAP) were recorded on the first day of ARDS; and oxygen index (OI) and OSI were calculated as (FiO₂ × MAP × 100)/PaO₂, and (FiO₂ × MAP × 100) /SpO₂ accordingly. During the study period, a total of 101 patients with ARDS were enrolled, and their mean age was 69.2 years. The overall in-ICU and in-hospital mortality rate was 57.4% and 61.4%, respectively. The patients with in-ICU mortality had higher APACHE II score than the survivors (31.6 ± 9.8 vs. 23.0 ± 9.1, < 0.001). In addition, mortalities had lower SpO₂, and SpO₂/FiO₂ ratios than the survivors (both < 0.05). In contrast, survivors had lower OI, and OSI than the mortalities (both = 0.008). Both OSI (area under curve (AUC) = 0.656, = 0.008) and OI (AUC = 0.654, = 0.008) had good predictive performance of mortality among ARDS patients using receiver-operating characteristics (ROC) curves analysis. In addition, the AUC of SpO₂/FiO₂ (AUC = 0.616, = 0.046) had better performance for mortality prediction than PaO₂/FiO₂ (AUC = 0.603, = 0.08). The patients with OSI greater than 12 had a higher risk of mortality than OSI < 12 (adjusted OR, 5.22, 95% CI, 1.31⁻20.76, = 0.019). In contrast, OI, PaO₂/FiO₂, and SpO₂/FiO₂ were not found to be significantly associated with increased mortality. OSI is significantly associated with the increased mortality of ARDS patients and can also be a good outcome predictor.
本研究旨在探讨氧合饱和度指数（OSI）与急性呼吸窘迫综合征（ARDS）患者预后之间的关联，并评估OSI对ARDS患者死亡率的预测性能。本研究在一家拥有66张成人重症监护病房（ICU）床位的地区医院进行。2016年11月1日至2018年5月31日期间确诊的所有ARDS患者，其临床信息均进行回顾性收集。记录ARDS第一天的最低PaO₂/FiO₂比值和SpO₂/FiO₂比值以及最高平均气道压（MAP）；并相应地计算氧指数（OI）和OSI，分别为（FiO₂×MAP×100）/PaO₂和（FiO₂×MAP×100）/SpO₂。研究期间，共纳入101例ARDS患者，平均年龄为69.2岁。ICU内和院内总死亡率分别为57.4%和61.4%。ICU内死亡患者的急性生理与慢性健康状况评分系统（APACHE）II评分高于存活患者（31.6±9.8 vs. 23.0±9.1，P<0.001）。此外，死亡患者的SpO₂和SpO₂/FiO₂比值低于存活患者（均P<0.05）。相比之下存活患者的OI和OSI低于死亡患者（均P = 0.008）。使用受试者工作特征（ROC）曲线分析，OSI（曲线下面积（AUC）=0.656，P = 0.008）和OI（AUC = 0.654，P = 0.008）对ARDS患者死亡率均具有良好的预测性能。此外，SpO₂/FiO₂的AUC（AUC = 0.616，P = 0.046）对死亡率预测的性能优于PaO₂/FiO₂（AUC = 0.603，P = 0.08）。OSI大于12的患者比OSI<12的患者死亡风险更高（校正比值比，5.22，95%可信区间，1.31⁻20.76，P = 0.019）。相比之下，未发现OI、PaO₂/FiO₂和SpO₂/FiO₂与死亡率增加有显著关联。OSI与ARDS患者死亡率增加显著相关，并且也可以作为一个良好的预后预测指标。
