Wu Shin-Hwar, Kor Chew-Teng, Chi Shu-Hua, Li Chun-Yu
Division of Critical Care Internal Medicine, Department of Emergency Medicine and Critical Care, Changhua Christian Hospital, Changhua 50006, Taiwan.
Big Data Center, Changhua Christian Hospital, Changhua 50006, Taiwan.
Diagnostics (Basel). 2023 Dec 24;14(1):37. doi: 10.3390/diagnostics14010037.
The oxygen saturation index (OSI), defined by FO/SO multiplied by the mean airway pressure, has been reported to exceed the Berlin definition in predicting the mortality of acute respiratory distress syndrome (ARDS). The OSI has served as an alternative to the Berlin definition in categorizing pediatric ARDS. However, the use of the OSI for the stratification of adult ARDS has not been reported. A total of 379 invasively ventilated adult ARDS patients were retrospectively studied. The ARDS patients were classified into three groups by their incidence rate of mortality: mild (OSI < 14.69), moderate (14.69 < OSI < 23.08) and severe (OSI > 23.08). OSI-based categorization was highly correlated with the Berlin definition by a Kendall's tau of 0.578 ( < 0.001). The Kaplan-Meier curves of the three OSI-based groups were significantly different ( < 0.001). By the Berlin definition, the hazard ratio for 28-day mortality was 0.58 (0.33-1.05) and 0.95 (0.55-1.67) for the moderate and severe groups, respectively (compared to the mild group). In contrast, the corresponding hazard ratio was 1.01 (0.69-1.47) and 2.39 (1.71-3.35) for the moderate and severe groups defined by the OSI. By multivariate analysis, OSI-based severe ARDS was independently associated with 28-D or 90-D mortality. In conclusion, we report the first OSI-based stratification for adult ARDS and find that it serves well as an alternative to the Berlin definition.
氧合指数（OSI）定义为吸入氧分数（FO）/动脉血氧分压（SO）乘以平均气道压，据报道，在预测急性呼吸窘迫综合征（ARDS）死亡率方面，该指数超过了柏林定义。在对儿科ARDS进行分类时，OSI已作为柏林定义的替代指标。然而，尚未有关于将OSI用于成人ARDS分层的报道。本研究对379例接受有创通气的成人ARDS患者进行了回顾性分析。根据死亡率将ARDS患者分为三组：轻度（OSI<14.69）、中度（14.69<OSI<23.08）和重度（OSI>23.08）。基于OSI的分类与柏林定义高度相关，肯德尔相关系数为0.578（<0.001）。三个基于OSI分组的Kaplan-Meier曲线有显著差异（<0.001）。按照柏林定义，中度和重度组28天死亡率的风险比分别为0.58（0.33 - 1.05）和0.95（0.55 - 1.67）（与轻度组相比）。相比之下，基于OSI定义的中度和重度组相应的风险比分别为1.01（0.69 - 1.47）和2.39（1.71 - 3.35）。多因素分析显示，基于OSI的重度ARDS与28天或90天死亡率独立相关。总之，我们首次报道了基于OSI的成人ARDS分层，并发现它可很好地作为柏林定义的替代指标。
