急性呼吸衰竭患者血氧饱和度与死亡率的关系。

IF 2.1 4区医学 Q3 MEDICINE, RESEARCH & EXPERIMENTAL

Advances in Clinical and Experimental Medicine Pub Date : 2024-12-06 DOI:10.17219/acem/189879

Li Ai, Ran Li, Xixian Teng, Jing Li, Bing Hai

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引用次数: 0

摘要

背景：不同国际指南推荐目标的可变性和差异表明急性呼吸衰竭（ARF）患者的最佳氧饱和度（SpO2）目标有待进一步探讨。目的：探讨动脉血氧饱和度与ARF患者住院死亡率的关系，确定ARF患者的最佳动脉血氧饱和度。材料和方法：在本队列研究中，随访结束时纳入3225例ARF患者；其中存活1249例，死亡1976例。绘制限制三次样条（restricted cubic spline， RCS）来显示SpO2中位数与ARF患者住院死亡风险之间的非线性关系，并确定SpO2的最佳范围。应用Cox回归分析确定急性肾功能衰竭患者SpO2中位数与住院死亡风险之间的关系。绘制Kaplan-Meier曲线以确定ARF患者的住院死亡率。结果：随访结束时，所有ARF患者住院死亡率为61.2%。校正混杂因素后，SpO2中位数与ARF患者住院死亡风险降低相关(风险比（HR) = 0.95, 95%可信区间（95% CI）： 0.93-0.97）。中位SpO2与ARF患者住院死亡率呈非线性相关。96% ~ 98%组总生存率（OS）较高。中位SpO2≤96%与ARF患者合并恶性肿瘤（HR = 1.55, 95% CI: 1.24-1.94）、肾功能衰竭（HR = 1.45, 95% CI: 1.24-1.70）、慢性阻塞性肺疾病(COPD；HR = 1.70, 95% CI: 1.27-2.28)和心房颤动(AF；Hr = 1.25, 95% ci: 1.02-1.53)。中位SpO2 bb0 98%与伴有房颤的ARF患者住院死亡风险升高相关（HR = 1.22, 95% CI: 1.04-1.44）。结论：中位SpO2与ARF患者住院死亡风险降低有关。

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Association of oxygen saturation and mortality in patients with acute respiratory failure.

Background: The variability and disparities in the recommended targets across different international guidelines suggest the optimal oxygen saturation (SpO2) target for acute respiratory failure (ARF) patients be further explored.

Objectives: To explore the association between SpO2 and in-hospital mortality of ARF patients, as well as to determine the optimum SpO2 for ARF patients.

Material and methods: In this cohort study, 3,225 ARF patients were included at the end of the follow-up; among them, and 1,249 patients survived and 1,976 died. The restricted cubic spline (RCS) was drawn to show the nonlinear association between the median SpO2 and the risk of in-hospital mortality of ARF patients and to identify the optimal range of SpO2. Cox regression was applied to identify the association between the median SpO2 and the risk of in-hospital mortality in ARF patients. Kaplan-Meier curves were plotted to identify the in-hospital mortality of ARF patients.

Results: The in-hospital mortality rate was 61.2% in all ARF patients at the end of the follow-up. The median SpO2 was associated with decreased risk of in-hospital mortality of ARF patients after adjusting for confounders (hazard ratio (HR) = 0.95, 95% confidence interval (95% CI): 0.93-0.97). The median SpO2 was non-linearly correlated with the in-hospital mortality of ARF patients. The overall survival (OS) was higher in the 96-98% group. A median SpO2 ≤ 96% was associated with an increased risk of in-hospital mortality in ARF patients accompanied by malignant cancer (HR = 1.55, 95% CI: 1.24-1.94), renal failure (HR = 1.45, 95% CI: 1.24-1.70), chronic obstructive pulmonary disease (COPD; HR = 1.70, 95% CI: 1.27-2.28) and atrial fibrillation (AF; HR = 1.25, 95% CI: 1.02-1.53). The median SpO2 > 98% was associated with an elevated risk of in-hospital mortality in ARF patients accompanied by AF (HR = 1.22, 95% CI: 1.04-1.44).

Conclusions: The median SpO2 was linked to a decreased risk of in-hospital mortality in ARF patients.

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来源期刊

Advances in Clinical and Experimental Medicine MEDICINE, RESEARCH & EXPERIMENTAL-

CiteScore

3.70

自引率

4.80%

发文量

153

审稿时长

6-12 weeks

期刊介绍： Advances in Clinical and Experimental Medicine has been published by the Wroclaw Medical University since 1992. Establishing the medical journal was the idea of Prof. Bogumił Halawa, Chair of the Department of Cardiology, and was fully supported by the Rector of Wroclaw Medical University, Prof. Zbigniew Knapik. Prof. Halawa was also the first editor-in-chief, between 1992-1997. The journal, then entitled "Postępy Medycyny Klinicznej i Doświadczalnej", appeared quarterly. Prof. Leszek Paradowski was editor-in-chief from 1997-1999. In 1998 he initiated alterations in the profile and cover design of the journal which were accepted by the Editorial Board. The title was changed to Advances in Clinical and Experimental Medicine. Articles in English were welcomed. A number of outstanding representatives of medical science from Poland and abroad were invited to participate in the newly established International Editorial Staff. Prof. Antonina Harłozińska-Szmyrka was editor-in-chief in years 2000-2005, in years 2006-2007 once again prof. Leszek Paradowski and prof. Maria Podolak-Dawidziak was editor-in-chief in years 2008-2016. Since 2017 the editor-in chief is prof. Maciej Bagłaj. Since July 2005, original papers have been published only in English. Case reports are no longer accepted. The manuscripts are reviewed by two independent reviewers and a statistical reviewer, and English texts are proofread by a native speaker. The journal has been indexed in several databases: Scopus, Ulrich’sTM International Periodicals Directory, Index Copernicus and since 2007 in Thomson Reuters databases: Science Citation Index Expanded i Journal Citation Reports/Science Edition. In 2010 the journal obtained Impact Factor which is now 1.179 pts. Articles published in the journal are worth 15 points among Polish journals according to the Polish Committee for Scientific Research and 169.43 points according to the Index Copernicus. Since November 7, 2012, Advances in Clinical and Experimental Medicine has been indexed and included in National Library of Medicine’s MEDLINE database. English abstracts printed in the journal are included and searchable using PubMed http://www.ncbi.nlm.nih.gov/pubmed.