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Peripheral Oxygen Saturation Facilitates Assessment of Respiratory Dysfunction in the Sequential Organ Failure Assessment Score With Implications for the Sepsis-3 Criteria
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- Karlsson Valik, John (author)
- Karolinska Institute,Karolinska Institutet, Sweden; Karolinska University Hospital, Sweden
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- Mellhammar, Lisa (author)
- Lund University,Lunds universitet,Infektionsmedicin,Sektion III,Institutionen för kliniska vetenskaper, Lund,Medicinska fakulteten,Translationell Sepsisforskning,Forskargrupper vid Lunds universitet,Infection Medicine (BMC),Section III,Department of Clinical Sciences, Lund,Faculty of Medicine,Translational Sepsis research,Lund University Research Groups,Lund University, Sweden
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- Sundén-Cullberg, Jonas (author)
- Karolinska Institutet,Karolinska Institute,Karolinska University Hospital, Sweden; Karolinska Institutet, Sweden
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- Ward, Logan (author)
- Treat Systems ApS, Denmark
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- Unge, Christian (author)
- Karolinska Institute,Karolinska Institutet, Sweden
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- Dalianis, Hercules (author)
- Stockholm University,Stockholms universitet,Institutionen för data- och systemvetenskap
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- Henriksson, Aron (author)
- Stockholm University,Stockholms universitet,Institutionen för data- och systemvetenskap
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- Strålin, Kristoffer (author)
- Karolinska Institutet,Karolinska Institute,Karolinska University Hospital, Sweden; Karolinska Institutet, Sweden
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- Linder, Adam (author)
- Lund University,Lunds universitet,Infektionsmedicin,Sektion III,Institutionen för kliniska vetenskaper, Lund,Medicinska fakulteten,Translationell Sepsisforskning,Forskargrupper vid Lunds universitet,SEBRA Sepsis and Bacterial Resistance Alliance,Heparinbindande protein inom thoraxkirurgi,Infection Medicine (BMC),Section III,Department of Clinical Sciences, Lund,Faculty of Medicine,Translational Sepsis research,Lund University Research Groups,Heparin bindning protein in cardiothoracic surgery,Lund University, Sweden
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- Nauclér, Pontus (author)
- Karolinska Institute,Karolinska Institutet, Sweden; Karolinska University Hospital, Sweden
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(creator_code:org_t)
- 2022
- 2022
- English.
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In: Critical Care Medicine. - 0090-3493 .- 1530-0293. ; 50:3, s. e272-e283
- Related links:
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http://dx.doi.org/10...
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https://urn.kb.se/re...
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https://doi.org/10.1...
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Abstract
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- OBJECTIVES: Sequential Organ Failure Assessment score is the basis of the Sepsis-3 criteria and requires arterial blood gas analysis to assess respiratory function. Peripheral oxygen saturation is a noninvasive alternative but is not included in neither Sequential Organ Failure Assessment score nor Sepsis-3. We aimed to assess the association between worst peripheral oxygen saturation during onset of suspected infection and mortality.DESIGN: Cohort study of hospital admissions from a main cohort and emergency department visits from four external validation cohorts between year 2011 and 2018. Data were collected from electronic health records and prospectively by study investigators.SETTING: Eight academic and community hospitals in Sweden and Canada.PATIENTS: Adult patients with suspected infection episodes.INTERVENTIONS: None.MEASUREMENTS AND MAIN RESULTS: The main cohort included 19,396 episodes (median age, 67.0 [53.0–77.0]; 9,007 [46.4%] women; 1,044 [5.4%] died). The validation cohorts included 10,586 episodes (range of median age, 61.0–76.0; women 42.1–50.2%; mortality 2.3–13.3%). Peripheral oxygen saturation levels 96–95% were not significantly associated with increased mortality in the main or pooled validation cohorts. At peripheral oxygen saturation 94%, the adjusted odds ratio of death was 1.56 (95% CI, 1.10–2.23) in the main cohort and 1.36 (95% CI, 1.00–1.85) in the pooled validation cohorts and increased gradually below this level. Respiratory assessment using peripheral oxygen saturation 94–91% and less than 91% to generate 1 and 2 Sequential Organ Failure Assessment points, respectively, improved the discrimination of the Sequential Organ Failure Assessment score from area under the receiver operating characteristics 0.75 (95% CI, 0.74–0.77) to 0.78 (95% CI, 0.77–0.80; p < 0.001). Peripheral oxygen saturation/Fio2 ratio had slightly better predictive performance compared with peripheral oxygen saturation alone, but the clinical impact was minor.CONCLUSIONS: These findings provide evidence for assessing respiratory function with peripheral oxygen saturation in the Sequential Organ Failure Assessment score and the Sepsis-3 criteria. Our data support using peripheral oxygen saturation thresholds 94% and 90% to get 1 and 2 Sequential Organ Failure Assessment respiratory points, respectively. This has important implications primarily for emergency practice, rapid response teams, surveillance, research, and resource-limited settings.
Subject headings
- NATURVETENSKAP -- Data- och informationsvetenskap -- Systemvetenskap, informationssystem och informatik (hsv//swe)
- NATURAL SCIENCES -- Computer and Information Sciences -- Information Systems (hsv//eng)
- MEDICIN OCH HÄLSOVETENSKAP -- Klinisk medicin -- Anestesi och intensivvård (hsv//swe)
- MEDICAL AND HEALTH SCIENCES -- Clinical Medicine -- Anesthesiology and Intensive Care (hsv//eng)
Keyword
- critical illness
- infections
- pulse oximetry
- respiratory failure
- sepsis
- Sequential Organ Failure Assessment scores
- data- och systemvetenskap
- Computer and Systems Sciences
- critical illness
- infections
- pulse oximetry
- respiratory failure
- sepsis
- Sequential Organ Failure Assessment scores
Publication and Content Type
- ref (subject category)
- art (subject category)
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- By the author/editor
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Karlsson Valik, ...
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Mellhammar, Lisa
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Sundén-Cullberg, ...
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Ward, Logan
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Unge, Christian
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Dalianis, Hercul ...
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Henriksson, Aron
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Strålin, Kristof ...
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Linder, Adam
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Nauclér, Pontus
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- About the subject
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- NATURAL SCIENCES
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NATURAL SCIENCES
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and Computer and Inf ...
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and Information Syst ...
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- MEDICAL AND HEALTH SCIENCES
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MEDICAL AND HEAL ...
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and Clinical Medicin ...
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and Anesthesiology a ...
- Articles in the publication
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Critical Care Me ...
- By the university
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Stockholm University
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Lund University
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Karolinska Institutet