PaO2/FiO2 ratio forecasts COVID-19 patients’ outcome regardless of age: a cross-sectional, monocentric study

Abstract

We studied the predictive value of the PaO2/FiO2 ratio for classifying COVID-19-positive patients who will develop severe clinical outcomes. One hundred fifty patients were recruited and categorized into two distinct populations (“A” and “B”), according to the indications given by the World Health Organization. Patients belonging the population “A” presented with mild disease not requiring oxygen support, whereas population “B” presented with a severe disease needing oxygen support. The AUC curve of PaO2/FiO2 in the discovery cohort was 0.838 (95% CI 0.771–0.908). The optimal cut-off value for distinguishing population “A” from the “B” one, calculated by Youden’s index, with sensitivity of 71.79% and specificity 85.25%, LR+4.866, LR−0.339, was < 274 mmHg. The AUC in the validation cohort of 170 patients overlapped the previous one, i.e., 0.826 (95% CI 0.760–0.891). PaO2/FiO2 ratio < 274 mmHg was a good predictive index test to forecast the development of a severe respiratory failure in SARS-CoV-2-infected patients. Moreover, our work highlights that PaO2/FiO2 ratio, compared to inflammatory scores (hs-CRP, NLR, PLR and LDH) indicated to be useful in clinical managements, results to be the most reliable parameter to identify patients who require closer respiratory monitoring and more aggressive supportive therapies. Clinical trial registration: Prognostic Score in COVID-19, prot. NCT04780373 https://clinicaltrials.gov/ct2/show/NCT04780373 (retrospectively registered).