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. 2024 May 31;19(5):e0304518.
doi: 10.1371/journal.pone.0304518. eCollection 2024.

Association between (ΔPaO2/FiO2)/PEEP and in-hospital mortality in patients with COVID-19 pneumonia: A secondary analysis

Youli Chen  1 , Huangen Li  1 , Jinhuang Lin  1 , Zhiwei Su  1 , Tianlai Lin  1
Affiliations

Association between (ΔPaO2/FiO2)/PEEP and in-hospital mortality in patients with COVID-19 pneumonia: A secondary analysis

Youli Chen et al. PLoS One. .

Abstract

Background: The arterial pressure of oxygen (PaO2)/inspiratory fraction of oxygen (FiO2) is associated with in-hospital mortality in patients with Coronavirus Disease 2019 (COVID-19) pneumonia. ΔPaO2/FiO2 [the difference between PaO2/FiO2 after 24 h of invasive mechanical ventilation (IMV) and PaO2/FiO2 before IMV] is associated with in-hospital mortality. However, the value of PaO2 can be influenced by the end-expiratory pressure (PEEP). To the best of our knowledge, the relationship between the ratio of (ΔPaO2/FiO2)/PEEP and in-hospital mortality remains unclear. This study aimed to evaluate their association.

Methods: The study was conducted in southern Peru from April 2020 to April 2021. A total of 200 patients with COVID-19 pneumonia requiring IMV were included in the present study. We analyzed the association between (ΔPaO2/FiO2)/PEEP and in-hospital mortality by Cox proportional hazards regression models.

Results: The median (ΔPaO2/FiO2)/PEEP was 11.78 mmHg/cmH2O [interquartile range (IQR) 8.79-16.08 mmHg/cmH2O], with a range of 1 to 44.36 mmHg/cmH2O. Patients were divided equally into two groups [low group (< 11.80 mmHg/cmH2O), and high group (≥ 11.80 mmHg/cmH2O)] according to the (ΔPaO2/FiO2)/PEEP ratio. In-hospital mortality was lower in the high (ΔPaO2/FiO2)/PEEP group than in the low (ΔPaO2/FiO2)/PEEP group [18 (13%) vs. 38 (38%)]; hazard ratio (HR), 0.33 [95% confidence intervals (CI), 0.17-0.61, P < 0.001], adjusted HR, 0.32 (95% CI, 0.11-0.94, P = 0.038). The finding that the high (ΔPaO2/FiO2)/PEEP group exhibited a lower risk of in-hospital mortality compared to the low (ΔPaO2/FiO2)/PEEP group was consistent with the results from the sensitivity analysis. After adjusting for confounding variables, we found that each unit increase in (ΔPaO2/FiO2)/PEEP was associated with a 12% reduction in the risk of in-hospital mortality (HR, 0.88, 95%CI, 0.80-0.97, P = 0.013).

Conclusions: The (ΔPaO2/FiO2)/PEEP ratio was associated with in-hospital mortality in patients with COVID-19 pneumonia. (ΔPaO2/FiO2)/PEEP might be a marker of disease severity in COVID-19 patients.

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Conflict of interest statement

The authors have declared that no competing interests exist.

Figures

Fig 1
Fig 1. Kaplan-Meier curves for patients in different (ΔPaO2/FiO2)/PEEP groups.
Fig 2
Fig 2. Smoothed curve between (ΔPaO2/FiO2)/PEEP and in-hospital mortality.
See this image and copyright information in PMC

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References

    1. Scendoni R, Gattari D, Cingolani M. COVID-19 Pulmonary Pathology, Ventilator-Induced Lung Injury (VILI), or Sepsis-Induced Acute Respiratory Distress Syndrome (ARDS)? Healthcare Considerations Arising From an Autopsy Case and Miny-Review. Clin Pathol. 2022; 15:2632010X221083223. doi: 10.1177/2632010X221083223 - DOI - PMC - PubMed
    1. Goyal P, Choi JJ, Pinheiro LC, Schenck EJ, Chen R, Jabri A, et al.. Clinical Characteristics of Covid-19 in New York City. N Engl J Med. 2020; 382(24):2372–2374. doi: 10.1056/NEJMc2010419 - DOI - PMC - PubMed
    1. Petrilli CM, Jones SA, Yang J, Rajagopalan H, O’Donnell L, Chernyak Y, et al.. Factors associated with hospital admission and critical illness among 5279 people with coronavirus disease 2019 in New York City: prospective cohort study. BMJ. 2020; 369:m1966. doi: 10.1136/bmj.m1966 - DOI - PMC - PubMed
    1. Schuijt MTU, Martin-Loeches I, Schultz MJ, Paulus F, Neto AS. Mortality associated with early changes in ARDS severity in COVID-19 patients—Insights from the PRoVENT-COVID study. J Crit Care. 2021; 65:237–245. doi: 10.1016/j.jcrc.2021.06.016 - DOI - PMC - PubMed
    1. Sartini S, Massobrio L, Cutuli O, Campodonico P, Bernini C, Sartini M, et al.. Role of SatO2, PaO2/FiO2 Ratio and PaO2 to Predict Adverse Outcome in COVID-19: A Retrospective, Cohort Study. Int J Environ Res Public Health, 2021; 18(21):11534. doi: 10.3390/ijerph182111534 - DOI - PMC - PubMed