Exertional hypoxia in patients without resting hypoxia is an early predictor of moderate to severe COVID-19.
COVID-19
Exertional Hypoxia
Hospital Medicine
Respiratory physiology
Journal
Internal and emergency medicine
ISSN: 1970-9366
Titre abrégé: Intern Emerg Med
Pays: Italy
ID NLM: 101263418
Informations de publication
Date de publication:
11 2021
11 2021
Historique:
received:
05
01
2021
accepted:
09
03
2021
pubmed:
27
3
2021
medline:
11
11
2021
entrez:
26
3
2021
Statut:
ppublish
Résumé
The importance of exertional hypoxia without resting hypoxia in COVID-19 is unknown and may help objectively identify high-risk patients. Interventions may be initiated earlier with sufficient lead-time between development of exertional hypoxia and other outcome measures. We performed a retrospective study of adult patients hospitalized with COVID-19 from March 1, 2020 to October 30, 2020 in an integrated academic medical system in the Chicagoland area. We analyzed patients who had daily exertional oximetry measurements taken. We defined exertional hypoxia as SpO2 < 90% with ambulation. We excluded patients who had first exertional oximetry measurements or first exertional hypoxia after the use of oxygen therapies. We determined the association of exertional hypoxia without resting hypoxia with the eventual need for nasal cannula or advanced oxygen therapies (defined as high flow nasal cannula, Bi-PAP, ventilator, or extracorporeal membrane oxygenation). We also calculated the time between development of exertional hypoxia and the need for oxygen therapies. Of 531 patients included, 132 (24.9%) had exertional hypoxia. Presence of exertional hypoxia was strongly associated with eventual use of nasal cannula (OR 4.8, 95% CI 2.8-8.4) and advanced oxygen therapy (IRR 7.7, 95% CI 3.4-17.5). Exertional hypoxia preceded nasal cannula use by a median 12.5 h [IQR 3.25, 29.25] and advanced oxygenation by 54 h [IQR 25, 82]. Exertional hypoxia without resting hypoxia may serve as an early, non-invasive physiologic marker for the likelihood of developing moderate to severe COVID-19. It may help clinicians triage patients and initiate earlier interventions.
Identifiants
pubmed: 33770368
doi: 10.1007/s11739-021-02708-w
pii: 10.1007/s11739-021-02708-w
pmc: PMC7994353
doi:
Types de publication
Journal Article
Langues
eng
Sous-ensembles de citation
IM
Pagination
2097-2103Informations de copyright
© 2021. Società Italiana di Medicina Interna (SIMI).
Références
Dong E, Du H, Gardner L (2020) An interactive web-based dashboard to track COVID-19 in real time. Lancet Infect Dis 20(5):533–534. https://doi.org/10.1016/S1473-3099(20)30120-1
doi: 10.1016/S1473-3099(20)30120-1
pubmed: 32087114
pmcid: 7159018
Wang Y, Dong C, Hu Y, Li C, Ren Q, Zhang X, Shi H, Zhou M (2020) Temporal changes of CT findings in 90 patients with COVID-19 pneumonia: a longitudinal study. Radiology 296(2):E55–E64. https://doi.org/10.1148/radiol.2020200843
doi: 10.1148/radiol.2020200843
pubmed: 32191587
Emergency Department COVID-19 Severity Classi-cation. https://www.acep.org/globalassets/sites/acep/media/covid-19-main/acep_evidencecare_covid19severitytool.pdf . Accessed 1/3/2021
Edward H. Suh LA, David Bodnar, Gerardo Chiricolo, Nicholas Gavin, Jonathon LeBaron, Laura Melville, Marie-Laure Romney, Manish Sharma, Amos J. Shemesh, Peter A.D. steel, Brenna M. Farmer (2020) ACEP COVID-19 Field Guide: Evaluation Pathway for Patietns with Possible COVID-19. https://www.acep.org/corona/covid-19-field-guide/risk-stratification/evaluation-pathway-for-patients-with-possible-covid-19/ . Accessed 1/3/2021
Zhang J, Yu KF (1998) What’s the relative risk? A method of correcting the odds ratio in cohort studies of common outcomes. JAMA 280(19):1690–1691. https://doi.org/10.1001/jama.280.19.1690
doi: 10.1001/jama.280.19.1690
pubmed: 9832001
Zou G (2004) A modified poisson regression approach to prospective studies with binary data. Am J Epidemiol 159(7):702–706. https://doi.org/10.1093/aje/kwh090
doi: 10.1093/aje/kwh090
pubmed: 15033648
Beigel JH, Tomashek KM, Dodd LE, Mehta AK, Zingman BS, Kalil AC, Hohmann E, Chu HY, Luetkemeyer A, Kline S, Lopez de Castilla D, Finberg RW, Dierberg K, Tapson V, Hsieh L, Patterson TF, Paredes R, Sweeney DA, Short WR, Touloumi G, Lye DC, Ohmagari N, Oh MD, Ruiz-Palacios GM, Benfield T, Fatkenheuer G, Kortepeter MG, Atmar RL, Creech CB, Lundgren J, Babiker AG, Pett S, Neaton JD, Burgess TH, Bonnett T, Green M, Makowski M, Osinusi A, Nayak S, Lane HC, Members A-SG (2020) Remdesivir for the treatment of Covid-19—final report. N Engl J Med 383(19):1813–1826. https://doi.org/10.1056/NEJMoa2007764
doi: 10.1056/NEJMoa2007764
pubmed: 32445440
Group RC, Horby P, Lim WS, Emberson JR, Mafham M, Bell JL, Linsell L, Staplin N, Brightling C, Ustianowski A, Elmahi E, Prudon B, Green C, Felton T, Chadwick D, Rege K, Fegan C, Chappell LC, Faust SN, Jaki T, Jeffery K, Montgomery A, Rowan K, Juszczak E, Baillie JK, Haynes R, Landray MJ (2020) Dexamethasone in hospitalized patients with Covid-19 - preliminary report. N Engl J Med. https://doi.org/10.1056/NEJMoa2021436
doi: 10.1056/NEJMoa2021436
Gheorghiade M, Follath F, Ponikowski P, Barsuk JH, Blair JE, Cleland JG, Dickstein K, Drazner MH, Fonarow GC, Jaarsma T, Jondeau G, Sendon JL, Mebazaa A, Metra M, Nieminen M, Pang PS, Seferovic P, Stevenson LW, van Veldhuisen DJ, Zannad F, Anker SD, Rhodes A, McMurray JJ, Filippatos G, European Society of C, European Society of Intensive Care M (2010) Assessing and grading congestion in acute heart failure: a scientific statement from the acute heart failure committee of the heart failure association of the European Society of Cardiology and endorsed by the European Society of Intensive Care Medicine. Eur J Heart Fail 12(5):423–433. https://doi.org/10.1093/eurjhf/hfq045
doi: 10.1093/eurjhf/hfq045
pubmed: 20354029
Rubin LJ (2012) The 6-minute walk test in pulmonary arterial hypertension: how far is enough? Am J Respir Crit Care Med 186(5):396–397. https://doi.org/10.1164/rccm.201206-1137ED
doi: 10.1164/rccm.201206-1137ED
pubmed: 22942342
Stoller JK, Panos RJ, Krachman S, Doherty DE, Make B, Long-term Oxygen Treatment Trial Research G (2010) Oxygen therapy for patients with COPD: current evidence and the long-term oxygen treatment trial. Chest 138(1):179–187. https://doi.org/10.1378/chest.09-2555
doi: 10.1378/chest.09-2555
pubmed: 20605816
pmcid: 2897694
Khor YH, Goh NS, Glaspole I, Holland AE, McDonald CF (2019) Exertional desaturation and prescription of ambulatory oxygen therapy in interstitial lung disease. Respir Care 64(3):299–306. https://doi.org/10.4187/respcare.06334
doi: 10.4187/respcare.06334
pubmed: 30377245
Noormohammadpour P, Abolhasani M (2020) Besides other signs, can a 6-min walk test be applied as a criterion for going to the hospital with a diagnosis of COVID-19? Adv J Emerg Med. https://doi.org/10.22114/ajem.v0i0.387
doi: 10.22114/ajem.v0i0.387
Pandit R, Vaity C, Mulakavalupil B, Matthew A, Sabnis K, Joshi S (2020) Unmasking Hypoxia in COVID 19 - Six Minute Walk Test. J Assoc Physicians India 68(9):50–51
pubmed: 32798345
Goodacre S, Thomas B, Lee E, Sutton L, Loban A, Waterhouse S, Simmonds R, Biggs K, Marincowitz C, Schutter J, Connelly S, Sheldon E, Hall J, Young E, Bentley A, Challen K, Fitzsimmons C, Harris T, Lecky F, Lee A, Maconochie I, Walter D (2020) Post-exertion oxygen saturation as a prognostic factor for adverse outcome in patients attending the emergency department with suspected COVID-19: a substudy of the PRIEST observational cohort study. Emerg Med J. https://doi.org/10.1136/emermed-2020-210528
doi: 10.1136/emermed-2020-210528
pubmed: 33273040
Hussain T, Saman HT, Yousaf Z (2020) Identification of Exertional Hypoxia and Its Implications in SARS-CoV-2 Pneumonia. Am J Trop Med Hyg 103(4):1742–1743. https://doi.org/10.4269/ajtmh.20-1012
doi: 10.4269/ajtmh.20-1012
pubmed: 32851969
pmcid: 7543840
Fuglebjerg NJU, Jensen TO, Hoyer N, Ryrso CK, Lindegaard B, Harboe ZB (2020) Silent hypoxia in patients with SARS CoV-2 infection before hospital discharge. Int J Infect Dis 99:100–101. https://doi.org/10.1016/j.ijid.2020.07.014
doi: 10.1016/j.ijid.2020.07.014
pubmed: 32663601
pmcid: 7836996