Which one is a better predictor of prognosis in COVID-19: Analytical biomarkers or PaO2/FiO2?

¿Cuál es mejor predictor del pronóstico en COVID-19: biomarcadores analíticos o PaO2/FiO2?

M. Rubio-Rivasa,

Corresponding author

[e-mail]

Corresponding author.

, J.M. Mora-Lujánb, A.M. Sáeza, M.D. Martín-Escalantec, V.G. Galvañd, G.M. de la Callee, M.L. Taboada Martínezf, A.M. Míguezg, C. Lumbreras-Bermejoe, J.-M. Antón-Santosh, on behalf of the SEMI-COVID-19 Network 1

a Department of Internal Medicine, Bellvitge University Hospital, Barcelona, Spain

b Department of Internal Medicine, Parc Sanitari Hospital del Mar, Barcelona, Spain

c Department of Internal Medicine, Costa del Sol Hospital, Marbella, Málaga, Spain

d Department of Internal Medicine, San Juan de Alicante University Hospital, Alicante, Spain

e Department of Internal Medicine, 12 de Octubre University Hospital, Madrid, Spain

f Department of Internal Medicine, Cabueñes Hospital, Gijón, Asturias, Spain

g Department of Internal Medicine, Gregorio Marañón University Hospital, Madrid, Spain

h Department of Internal Medicine, Infanta Cristina University Hospital, Parla, Madrid, Spain

Abstract

Background

The study aimed to describe patient characteristics and outcomes by PaO2/FiO2 (PAFI) and degree of inflammation.

Methods

Retrospective cohort study with data on patients collected from March 1st, 2020 to March 1st, 2023, from the Spanish SEMI-COVID-19 Registry. Non-nosocomial patients with data on PAFI (<100 vs. 100−200 vs. 200−300 vs. >300) who received corticosteroids (CS) for COVID-19 in the first 48 h of admission were included in the study. 5314 patients met the inclusion criteria for the present study. The primary outcome was in-hospital mortality.

Results

Higher in-hospital mortality was found in the groups with PAFI < 100 (51.5% vs. 41.2% vs. 25.8% vs. 12.3%, P < .001). They also required more NIMV, IMV, and ICU admission, and had longer hospital stays. Those patients with PAFI > 300 and 4–5 high-risk criteria presented higher mortality than the patients with PAFI 200−300 and only 1−2 criteria of analytical inflammation. Risk factors associated with higher in-hospital mortality were age [OR = 1.06 (1.05−1.06)], moderate [OR = 1.87 (1.49−2.33)] and severe [OR = 2.64 (1.96−3.55)] degree of dependency, dyslipidemia [OR = 1.20 (1.03−1.39)], higher Charlson index [OR = 1.19 (1.14−1.24)], tachypnea on admission [2.23 (1.91−2.61)], the higher number of high-risk criteria on admission, and lower PAFI on admission. Female gender [OR = 0.77 (0.65−0.90)] and the use of RDSV [OR = 0.72 (0.56−0.93)] were found to be protective factors.

Conclusions

The lower the PAFI and the higher the degree of inflammation in COVID-19, the higher the in-hospital mortality. Inflammatory escalation precedes respiratory deterioration and should serve as an early predictor of severity to deciding the use of anti-inflammatory/immunosuppressive therapy.

Keywords:

COVID-19

PaO2/FiO2

Inflammation

Prognosis

Mortality

Abbreviations:

BMI

COPD

CRP

CS

HFNC

ICU

IMV

IQR

LDH

LMWH

NIMV

OSAS

PAFI

PCR

RDSV

SD

SEMI

TCZ

Resumen

Antecedentes

El estudio tenía como objetivo describir las características y los resultados de los pacientes según la PaO2/FiO2 (PAFI) y el grado de inflamación.

Métodos

Estudio de cohortes retrospectivo con datos de pacientes recogidos desde el 1 de marzo de 2020 hasta el 1 de marzo de 2023, del Registro Español SEMI-COVID-19. Se incluyeron en el estudio pacientes no nosocomiales con datos de PAFI (<100 vs 100−200 vs 200−300 vs >300) que recibieron corticoides (CS) por COVID-19 en las primeras 48 h de ingreso. 5.314 pacientes cumplieron los criterios de inclusión para el presente estudio. El resultado primario fue la mortalidad intrahospitalaria.

Resultados

Se encontró mayor mortalidad intrahospitalaria en los grupos con PAFI < 100 (51,5% vs 41,2% vs 25,8% vs 12,3%, P < ,001). También requirieron más VMNI, VMI e ingreso en UCI, y tuvieron estancias hospitalarias más prolongadas. Los pacientes con PAFI > 300 y 4–5 criterios de alto riesgo presentaron mayor mortalidad que los pacientes con PAFI 200−300 y sólo 1−2 criterios de inflamación analítica. Los factores de riesgo asociados a una mayor mortalidad intrahospitalaria fueron la edad [OR = 1,06 (1,05–1,06)], el grado de dependencia moderado [OR = 1,87 (1,49–2,33)] y grave [OR = 2,64 (1,96–3,55)], la dislipidemia [OR = 1. 20 (1,03–1,39)], mayor índice de Charlson [OR = 1,19 (1,14–1,24)], taquipnea al ingreso [2,23 (1,91–2,61)], mayor número de criterios de alto riesgo al ingreso y menor PAFI al ingreso. El sexo femenino [OR = 0,77 (0,65–0,90)] y el uso de RDSV [OR = 0,72 (0,56–0,93)] resultaron ser factores protectores.

Conclusiones

A menor PAFI y mayor grado de inflamación en COVID-19, mayor mortalidad intrahospitalaria. La escalada inflamatoria precede al deterioro respiratorio y debería servir como predictor precoz de gravedad para decidir el uso de terapia antiinflamatoria/inmunosupresora.

Palabras clave:

COVID-19

PaO2/FiO2

Inflamación

Pronóstico

Mortalidad