Division of Sleep and Circadian Disorders, Departments of Medicine and Neurology, Brigham & Women's Hospital & Harvard Medical School, Boston, Massachusetts, USA.
Sleep Medicine and Respiratory Function Unit, Maugeri Clinical and Scientific Institutes IRCCS, Pavia, Italy.
Respirology. 2022 Dec;27(12):1073-1082. doi: 10.1111/resp.14336. Epub 2022 Aug 7.
COVID-19 remains a major cause of respiratory failure, and means to identify future deterioration is needed. We recently developed a prediction score based on breath-holding manoeuvres (desaturation and maximal duration) to predict incident adverse COVID-19 outcomes. Here we prospectively validated our breath-holding prediction score in COVID-19 patients, and assessed associations with radiological scores of pulmonary involvement.
Hospitalized COVID-19 patients (N = 110, three recruitment centres) performed breath-holds at admission to provide a prediction score (Messineo et al.) based on mean desaturation (20-s breath-holds) and maximal breath-hold duration, plus baseline saturation, body mass index and cardiovascular disease. Odds ratios for incident adverse outcomes (composite of bi-level ventilatory support, ICU admission and death) were described for patients with versus without elevated scores (>0). Regression examined associations with chest x-ray (Brixia score) and computed tomography (CT; 3D-software quantification). Additional comparisons were made with the previously-validated '4C-score'.
Elevated prediction score was associated with adverse COVID-19 outcomes (N = 12/110), OR[95%CI] = 4.54[1.17-17.83], p = 0.030 (positive predictive value = 9/48, negative predictive value = 59/62). Results were diminished with removal of mean desaturation from the prediction score (OR = 3.30[0.93-11.72]). The prediction score rose linearly with Brixia score (β[95%CI] = 0.13[0.02-0.23], p = 0.026, N = 103) and CT-based quantification (β = 1.02[0.39-1.65], p = 0.002, N = 45). Mean desaturation was also associated with both radiological assessment. Elevated 4C-scores (≥high-risk category) had a weaker association with adverse outcomes (OR = 2.44[0.62-9.56]).
An elevated breath-holding prediction score is associated with almost five-fold increased adverse COVID-19 outcome risk, and with pulmonary deficits observed in chest imaging. Breath-holding may identify COVID-19 patients at risk of future respiratory failure.
COVID-19 仍是导致呼吸衰竭的主要原因，因此需要找到预测疾病恶化的方法。我们最近开发了一种基于屏气试验（饱和度下降和最大持续时间）的预测评分，用于预测 COVID-19 不良结局。本研究前瞻性验证了该评分在 COVID-19 患者中的有效性，并评估了其与肺部受累的影像学评分之间的相关性。
110 例住院 COVID-19 患者（来自 3 个中心）在入院时进行屏气试验，以提供基于平均饱和度下降（20 秒屏气试验）和最大屏气持续时间的预测评分（Messineo 等），同时还包括基线饱和度、体重指数和心血管疾病。描述了评分升高（>0）患者与无升高患者之间不良结局（双水平通气支持、入住 ICU 和死亡的复合结局）的比值比（OR）。回归分析用于评估与胸部 X 线（Brixia 评分）和计算机断层扫描（CT；3D 软件定量）的相关性。与之前验证过的“4C 评分”进行了额外比较。
评分升高与 COVID-19 不良结局相关（N=12/110），OR[95%CI]为 4.54[1.17-17.83]，p=0.030（阳性预测值为 9/48，阴性预测值为 59/62）。去除预测评分中的平均饱和度后，结果减弱（OR=3.30[0.93-11.72]）。评分与 Brixia 评分呈线性升高（β[95%CI]为 0.13[0.02-0.23]，p=0.026，N=103）和 CT 定量呈线性升高（β=1.02[0.39-1.65]，p=0.002，N=45）。平均饱和度也与两种影像学评估相关。升高的 4C 评分（≥高危类别）与不良结局的相关性较弱（OR=2.44[0.62-9.56]）。
屏气试验预测评分升高与 COVID-19 不良结局的风险增加近五倍相关，且与胸部影像学上观察到的肺部缺陷相关。屏气试验可能识别出有未来呼吸衰竭风险的 COVID-19 患者。
