Ye Yuanwen, Li Feifei, Yang Baohua, Lin Liangen, Chen Linglong
Department of Emergency, Wenzhou People's Hospital, Wenzhou 325000, Zhejiang, China. Corresponding author: Chen Linglong, Email:
Zhonghua Wei Zhong Bing Ji Jiu Yi Xue. 2024 Aug;36(8):813-820. doi: 10.3760/cma.j.cn121430-20231019-00885.
To explore the optimal pulse oxygen saturation (SpO) range during hospitalization for patients with sepsis.
A case-control study design was employed. Demographic information, vital signs, comorbidities, laboratory parameters, critical illness scores, clinical treatment information, and clinical outcomes of sepsis patients were extracted from the Medical Information Mart for Intensive Care- IV (MIMIC- IV). A generalized additive model (GAM) combined with a Loess smoothing function was employed to analyze and visualize the nonlinear relationship between SpO levels during hospitalization and in-hospital all-cause mortality. The optimal range of SpO was determined, and Logistic regression model along with Kaplan-Meier curve were utilized to validate the association between the determined range of SpO and in-hospital all-cause mortality.
A total of 5 937 patients met the inclusion criteria, among whom 1 191 (20.1%) died during hospitalization. GAM analysis revealed a nonlinear and U-shaped relationship between SpO levels and in-hospital all-cause mortality among sepsis patients during hospitalization. Multivariable Logistic regression analysis further confirmed that patients with SpO levels between 0.96 and 0.98 during hospitalization had a decreased mortality compared to those with SpO < 0.96 [hypoxia group; odds ratio (OR) = 2.659, 95% confidence interval (95%CI) was 2.190-3.229, P < 0.001] and SpO > 0.98 (hyperoxia group; OR = 1.594, 95%CI was 1.337-1.900, P < 0.001). Kaplan-Meier survival curve showed that patients with SpO between 0.96 and 0.98 during hospitalization had a higher probability of survival than those patient with SpO < 0.96 and SpO > 0.98 (Log-Rank test: χ = 113.400, P < 0.001). Sensitivity analyses demonstrated that, with the exception of subgroups with smaller sample sizes, across the strata of age, gender, body mass index (BMI), admission type, race, heart rate, systolic blood pressure, diastolic blood pressure, mean arterial pressure, respiratory rate, body temperature, myocardial infarction, congestive heart failure, cerebrovascular disease, chronic liver disease, diabetes mellitus, sequential organ failure assessment (SOFA), simplified acute physiology score II (SAPS II), systemic inflammatory response syndrome score (SIRS), and Glasgow coma score (GCS), the mortality of patients with SpO between 0.96 and 0.98 was significantly lower than those of patients with SpO < 0.96 and SpO > 0.98.
During hospitalization, the level of SpO among sepsis patients exhibits a U-shaped relationship with in-hospital all-cause mortality, indicating that heightened and diminished oxygen levels are both associated with increased mortality risk. The optimal SpO range is determined to be between 0.96 and 0.98.
探讨脓毒症患者住院期间的最佳脉搏血氧饱和度（SpO）范围。
采用病例对照研究设计。从重症监护医学信息数据库-IV（MIMIC-IV）中提取脓毒症患者的人口统计学信息、生命体征、合并症、实验室参数、危重病评分、临床治疗信息及临床结局。采用广义相加模型（GAM）结合局部加权回归散点平滑（Loess）函数分析并可视化住院期间SpO水平与院内全因死亡率之间的非线性关系。确定SpO的最佳范围，并利用逻辑回归模型和Kaplan-Meier曲线验证所确定的SpO范围与院内全因死亡率之间的关联。
共有5937例患者符合纳入标准，其中1191例（20.1%）在住院期间死亡。GAM分析显示，住院期间脓毒症患者的SpO水平与院内全因死亡率之间呈非线性U型关系。多变量逻辑回归分析进一步证实，住院期间SpO水平在0.96至0.98之间的患者与SpO<0.96（低氧组；比值比（OR）=2.659，95%置信区间（95%CI）为2.190-3.229，P<0.001）和SpO>0.98（高氧组；OR=1.594，95%CI为1.337-1.900，P<0.001）的患者相比，死亡率降低。Kaplan-Meier生存曲线显示，住院期间SpO在0.96至0.98之间的患者比SpO<0.96和SpO>0.98的患者生存概率更高（对数秩检验：χ =113.400，P<0.001）。敏感性分析表明，除样本量较小的亚组外，在年龄、性别、体重指数（BMI）、入院类型、种族、心率、收缩压、舒张压、平均动脉压、呼吸频率、体温、心肌梗死、充血性心力衰竭、脑血管疾病、慢性肝病、糖尿病、序贯器官衰竭评估（SOFA）、简化急性生理学评分II（SAPS II）、全身炎症反应综合征评分（SIRS）和格拉斯哥昏迷评分（GCS）各分层中，SpO在0.96至0.98之间的患者死亡率显著低于SpO<0.96和SpO>0.98的患者。
住院期间，脓毒症患者的SpO水平与院内全因死亡率呈U型关系，提示氧水平升高和降低均与死亡风险增加相关。确定最佳SpO范围为0.96至0.98。
