Abstract
Coronavirus disease 2019 (COVID-19) is a newly recognized infectious disease which can lead to acute respiratory distress syndrome requiring ventilatory support and intensive care unit admission. The aim of our study is to evaluate the performance of two non-invasive respiratory function indices (the ROX index and the SatO2/FiO2 ratio), as compared to the traditional PaO2/FiO2 ratio, in predicting a clinically relevant composite outcome (death or intubation) in hospitalized patients for COVID-19 pneumonia. Four hospital centers in Northern Italy conducted an observational retrospective cohort study during the first wave of COVID-19 pandemic. Four hundred and fifty-six patients with COVID-19 pneumonia admitted to medical or sub-intensive wards were enrolled. Clinical, laboratory, and respiratory parameters, for the calculation of different indices, were measured at hospital admission. In medical wards (Verona and Padua) the PaO2/FiO2 ratio, ROX index and SatO2/FiO2 ratio were able to predict intubation or death with good accuracy (AUROC for the PaO2/FiO2 ratio, ROX index and SatO2/FiO2 ratio of 75%, 75% and 74%, respectively). Regarding sub-intensive wards (Milan and Mantua), none of the three respiratory function indices was significantly associated with the composite outcome. In patients admitted to medical wards for COVID-19 pneumonia, the ROX index and the SatO2/FiO2 ratio demonstrated not only good performance in predicting intubation or death, but their accuracy was comparable to that of the PaO2/FiO2 ratio. In this setting, where repeated arterial blood gas tests are not always feasible, they could be considered a reliable alternative to the invasive PaO2/FiO2 ratio.
Highlights
Coronavirus disease 2019 (COVID-19) is a newly recognized infectious disease caused by severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) which has rapidly spread around the world reaching pandemic proportions [1]
In the medical wards (Verona and Padua) 30 patients required non-invasive ventilation (NIV) after hospital admission, while 51 patients were transferred to the intensive care unit (ICU) for intubation and 45 died
In the sub-intensive wards (Milan and Mantua) 121 patients underwent NIV during hospitalization, while the numbers of patients transferred to the ICU for intubation or deceased were 16 and 33, respectively (Fig. 1)
Summary
Coronavirus disease 2019 (COVID-19) is a newly recognized infectious disease caused by severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) which has rapidly spread around the world reaching pandemic proportions [1]. During the COVID-19 outbreak in Italy, patients not immediately requiring ICU were hospitalized either in medical wards, where oxygen could be primarily delivered with Venturi masks and masks with reservoir bags, or in sub-intensive wards, where high-flux nasal oxygen (HFNC), as well as continuous positive airway pressure (cPAP) and non-invasive ventilation (NIV) were available. These patients often needed to be transferred urgently to the ICU for mechanical ventilation because of respiratory failure refractory to oxygen therapy or NIV [5,6,7,8]. The PaO2/FiO2 ratio helps in patients risk stratification identifying three different categories of ARDS severity (mild, moderate, and severe) [11]
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