目的:探讨脓毒症患者住院期间的最佳脉搏血氧饱和度(SpO2)范围。
方法:采用病例对照研究设计。人口统计信息,生命体征,合并症,实验室参数,危重病评分,临床治疗信息,和脓毒症患者的临床结局从医学信息集市进行强化护理-IV(MIMIC-IV)。采用广义加性模型(GAM)结合黄土平滑函数来分析和可视化住院期间SpO2水平与院内全因死亡率之间的非线性关系。确定了SpO2的最佳范围,和Logistic回归模型以及Kaplan-Meier曲线用于验证确定的SpO2范围与院内全因死亡率之间的相关性.
结果:共有5937例患者符合纳入标准,其中1191人(20.1%)在住院期间死亡。GAM分析显示,住院期间脓毒症患者的SpO2水平与院内全因死亡率之间存在非线性和U型关系。多变量Logistic回归分析进一步证实,住院期间SpO2水平在0.96-0.98之间的患者死亡率低于SpO2<0.96[低氧组;比值比(OR)=2.659,95%置信区间(95CI)为2.190-3.229,P<0.001],SpO2>0.98(高氧组;OR=1.594,95CI为1.337-1.900,P<0.001)。Kaplan-Meier生存曲线显示,住院期间SpO2在0.96~0.98的患者生存概率高于SpO2<0.96且SpO2>0.98的患者(Log-Rank检验:χ2=113.400,P<0.001)。敏感性分析表明,除了样本量较小的子组,跨越年龄的阶层,性别,体重指数(BMI),入学类型,种族,心率,收缩压,舒张压,平均动脉压,呼吸频率,体温,心肌梗塞,充血性心力衰竭,脑血管疾病,慢性肝病,糖尿病,序贯器官衰竭评估(SOFA),简化急性生理学评分II(SAPSII),全身炎症反应综合征评分(SIRS),格拉斯哥昏迷评分(GCS),SpO2在0.96~0.98之间的患者死亡率明显低于SpO2<0.96和SpO2>0.98的患者.
结论:住院期间,脓毒症患者的SpO2水平与院内全因死亡率呈U型关系,表明氧气水平升高和减少都与死亡风险增加相关。最佳SpO2范围被确定为在0.96和0.98之间。
OBJECTIVE: To explore the optimal pulse oxygen saturation (SpO2) range during hospitalization for patients with sepsis.
METHODS: A case-control study design was employed. Demographic information, vital signs, comorbidities, laboratory parameters, critical illness scores, clinical treatment information, and clinical outcomes of sepsis patients were extracted from the Medical Information Mart for Intensive Care- IV (MIMIC- IV). A generalized additive model (GAM) combined with a Loess smoothing function was employed to analyze and visualize the nonlinear relationship between SpO2 levels during hospitalization and in-hospital all-cause mortality. The optimal range of SpO2 was determined, and Logistic regression model along with Kaplan-Meier curve were utilized to validate the association between the determined range of SpO2 and in-hospital all-cause mortality.
RESULTS: A total of 5 937 patients met the inclusion criteria, among whom 1 191 (20.1%) died during hospitalization. GAM analysis revealed a nonlinear and U-shaped relationship between SpO2 levels and in-hospital all-cause mortality among sepsis patients during hospitalization. Multivariable Logistic regression analysis further confirmed that patients with SpO2 levels between 0.96 and 0.98 during hospitalization had a decreased mortality compared to those with SpO2 < 0.96 [hypoxia group; odds ratio (OR) = 2.659, 95% confidence interval (95%CI) was 2.190-3.229, P < 0.001] and SpO2 > 0.98 (hyperoxia group; OR = 1.594, 95%CI was 1.337-1.900, P < 0.001). Kaplan-Meier survival curve showed that patients with SpO2 between 0.96 and 0.98 during hospitalization had a higher probability of survival than those patient with SpO2 < 0.96 and SpO2 > 0.98 (Log-Rank test: χ 2 = 113.400, P < 0.001). Sensitivity analyses demonstrated that, with the exception of subgroups with smaller sample sizes, across the strata of age, gender, body mass index (BMI), admission type, race, heart rate, systolic blood pressure, diastolic blood pressure, mean arterial pressure, respiratory rate, body temperature, myocardial infarction, congestive heart failure, cerebrovascular disease, chronic liver disease, diabetes mellitus, sequential organ failure assessment (SOFA), simplified acute physiology score II (SAPS II), systemic inflammatory response syndrome score (SIRS), and Glasgow coma score (GCS), the mortality of patients with SpO2 between 0.96 and 0.98 was significantly lower than those of patients with SpO2 < 0.96 and SpO2 > 0.98.
CONCLUSIONS: During hospitalization, the level of SpO2 among sepsis patients exhibits a U-shaped relationship with in-hospital all-cause mortality, indicating that heightened and diminished oxygen levels are both associated with increased mortality risk. The optimal SpO2 range is determined to be between 0.96 and 0.98.