School of Health and Related Research (ScHARR), University of Sheffield, Sheffield, UK
School of Health and Related Research (ScHARR), University of Sheffield, Sheffield, UK.
Emerg Med J. 2021 Feb;38(2):88-93. doi: 10.1136/emermed-2020-210528. Epub 2020 Dec 3.
Measurement of post-exertion oxygen saturation has been proposed to assess illness severity in suspected COVID-19 infection. We aimed to determine the accuracy of post-exertional oxygen saturation for predicting adverse outcome in suspected COVID-19.
We undertook a substudy of an observational cohort study across 70 emergency departments during the first wave of the COVID-19 pandemic in the UK. We collected data prospectively, using a standardised assessment form, and retrospectively, using hospital records, from patients with suspected COVID-19, and reviewed hospital records at 30 days for adverse outcome (death or receiving organ support). Patients with post-exertion oxygen saturation recorded were selected for this analysis. We constructed receiver-operating characteristic curves, calculated diagnostic parameters, and developed a multivariable model for predicting adverse outcome.
We analysed data from 817 patients with post-exertion oxygen saturation recorded after excluding 54 in whom measurement appeared unfeasible. The c-statistic for post-exertion change in oxygen saturation was 0.589 (95% CI 0.465 to 0.713), and the positive and negative likelihood ratios of a 3% or more desaturation were, respectively, 1.78 (1.25 to 2.53) and 0.67 (0.46 to 0.98). Multivariable analysis showed that post-exertion oxygen saturation was not a significant predictor of adverse outcome when baseline clinical assessment was taken into account (p=0.368). Secondary analysis excluding patients in whom post-exertion measurement appeared inappropriate resulted in a c-statistic of 0.699 (0.581 to 0.817), likelihood ratios of 1.98 (1.26 to 3.10) and 0.61 (0.35 to 1.07), and some evidence of additional prognostic value on multivariable analysis (p=0.019).
Post-exertion oxygen saturation provides modest prognostic information in the assessment of selected patients attending the emergency department with suspected COVID-19.
ISRCTN Registry (ISRCTN56149622) http://www.isrctn.com/ISRCTN28342533.
运动后血氧饱和度的测量被提议用于评估疑似 COVID-19 感染的疾病严重程度。我们旨在确定运动后血氧饱和度对预测疑似 COVID-19 不良结局的准确性。
我们在英国 COVID-19 大流行的第一波期间在 70 个急诊科进行了一项观察性队列研究的子研究。我们使用标准化评估表前瞻性地收集数据，并使用医院记录回顾性地收集数据，从疑似 COVID-19 患者中收集数据，并在 30 天内查看医院记录以确定不良结局（死亡或接受器官支持）。选择记录了运动后血氧饱和度的患者进行这项分析。我们构建了受试者工作特征曲线，计算了诊断参数，并为预测不良结局开发了一个多变量模型。
我们分析了排除 54 名因测量似乎不可行而排除的患者后记录了运动后血氧饱和度的 817 名患者的数据。运动后血氧饱和度变化的 c 统计量为 0.589（95%CI 0.465 至 0.713），血氧饱和度下降 3%或更多的阳性和阴性似然比分别为 1.78（1.25 至 2.53）和 0.67（0.46 至 0.98）。多变量分析表明，考虑到基线临床评估，运动后血氧饱和度不是不良结局的显著预测因素（p=0.368）。排除运动后测量似乎不合适的患者的二次分析导致 c 统计量为 0.699（0.581 至 0.817），似然比为 1.98（1.26 至 3.10）和 0.61（0.35 至 1.07），以及多变量分析中有一些额外预后价值的证据（p=0.019）。
在评估因疑似 COVID-19 而就诊急诊科的选定患者时，运动后血氧饱和度提供了适度的预后信息。
ISRCTN Registry（ISRCTN56149622）http://www.isrctn.com/ISRCTN28342533。
