Sirohiya Prashant, Elavarasi Arunmozhimaran, Sagiraju Hari Krishna Raju, Baruah Madhusmita, Gupta Nishkarsh, Garg Rohit Kumar, Paul Saurav Sekhar, Ratre Brajesh Kumar, Singh Ram, Kumar Balbir, Vig Saurabh, Pandit Anuja, Kumar Abhishek, Garg Rakesh, Meena Ved Prakash, Mittal Saurabh, Pahuja Saurabh, Das Nupur, Dwivedi Tanima, Gupta Ritu, Kumar Sunil, Pandey Manisha, Mishra Abhinav, Matharoo Karanvir Singh, Mohan Anant, Guleria Randeep, Bhatnagar Sushma
Department of Onco-anesthesia and Palliative Medicine, All India Institute of Medical Sciences, New Delhi, India.
Department of Neurology, All India Institute of Medical Sciences, New Delhi, India.
Lung India. 2022 May-Jun;39(3):247-253. doi: 10.4103/lungindia.lungindia_601_21.
Hypoxia in patients with COVID-19 is one of the strongest predictors of mortality. Silent hypoxia is characterised by the presence of hypoxia without dyspnoea. Silent hypoxia has been shown to affect the outcome in previous studies.
This was a retrospective study of a cohort of patients with SARS-CoV-2 infection who were hypoxic at presentation. Clinical, laboratory and treatment parameters in patients with silent hypoxia and dyspnoeic hypoxia were compared. Multivariate logistic regression models were fitted to identify the factors predicting mortality.
Among 2080 patients with COVID-19 admitted to our hospital, 811 patients were hypoxic with SpO <94% at the time of presentation. Among them, 174 (21.45%) did not have dyspnoea since the onset of COVID-19 symptoms. Further, 5.2% of patients were completely asymptomatic for COVID-19 and were found to be hypoxic only on pulse oximetry. The case fatality rate in patients with silent hypoxia was 45.4% as compared to 40.03% in dyspnoeic hypoxic patients (P = 0.202). The odds ratio of death was 1.1 (95% CI: 0.41-2.97) in the patients with silent hypoxia after adjusting for baseline characteristics, laboratory parameters, treatment and in-hospital complications, which did not reach statistical significance (P = 0.851).
Silent hypoxia may be the only presenting feature of COVID-19. As the case fatality rate is comparable between silent and dyspnoeic hypoxia, it should be recognised early and treated as aggressively. Because home isolation is recommended in patients with COVID-19, it is essential to use pulse oximetry in the home setting to identify these patients.
新型冠状病毒肺炎（COVID-19）患者的低氧血症是最强的死亡预测因素之一。静息性低氧血症的特征是存在低氧血症但无呼吸困难。在先前的研究中，静息性低氧血症已被证明会影响预后。
这是一项对出现低氧血症的严重急性呼吸综合征冠状病毒2（SARS-CoV-2）感染患者队列的回顾性研究。比较了静息性低氧血症和呼吸困难性低氧血症患者的临床、实验室和治疗参数。采用多因素逻辑回归模型确定预测死亡的因素。
在我院收治的2080例COVID-19患者中，811例患者在就诊时存在SpO<94%的低氧血症。其中，174例（21.45%）自COVID-19症状出现以来无呼吸困难。此外，5.2%的患者COVID-19完全无症状，仅通过脉搏血氧饱和度测定发现低氧血症。静息性低氧血症患者的病死率为45.4%，而呼吸困难性低氧血症患者为40.03%（P = 0.202）。在调整基线特征、实验室参数、治疗和院内并发症后，静息性低氧血症患者的死亡比值比为1.1（95%可信区间：0.41-2.97），未达到统计学显著性（P = 0.851）。
静息性低氧血症可能是COVID-19的唯一表现特征。由于静息性和呼吸困难性低氧血症的病死率相当，应尽早识别并积极治疗。由于建议COVID-19患者居家隔离，因此在家庭环境中使用脉搏血氧饱和度测定来识别这些患者至关重要。
