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首页> 外文期刊>Indian Journal of Critical Care Medicine >Arterial Blood Gas as a Predictor of Mortality in COVID Pneumonia Patients Initiated on Noninvasive Mechanical Ventilation: A Retrospective Analysis
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Arterial Blood Gas as a Predictor of Mortality in COVID Pneumonia Patients Initiated on Noninvasive Mechanical Ventilation: A Retrospective Analysis

机译：动脉血气作为在非侵入式机械通气的Covid肺炎患者中死亡率的预测因素：回顾性分析

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Background: The alveolar–arterial oxygen (A–a) gradient measures the difference between the oxygen concentration in alveoli and the arterial system, which has considerable clinical utility. Materials and methods: It was a retrospective, observational cohort study involving the analysis of patients diagnosed with acute COVID pneumonia and required noninvasive mechanical ventilation (NIV) over a period of 3 months. The primary objective was to investigate the utility of the A–a gradient (pre-NIV) as a predictor of 28-day mortality in COVID pneumonia. The secondary objective included the utility of other arterial blood gas (ABG) parameters (pre-NIV) as a predictor of 28-day mortality. The outcome was also compared between survivors and nonsurvivors. The outcome variables were analyzed by receiver-operating characteristic (ROC) curve, Youden index, and regression analysis. Results: The optimal criterion for A–a gradient to predict 28-day mortality was calculated as ≤430.43 at a Youden index of 0.5029, with the highest area under the curve (AUC) of 0.755 (p 0.0001). On regression analysis, the odds ratio for the A–a gradient was 0.99. A significant difference was observed in ABG predictors, including PaO2, PaCO2, A–a gradient, AO2, and arterial–alveolar (a–A) (%) among nonsurvivors vs survivors (p-value 0.001). The vasopressor requirement, need for renal replacement therapy, total parenteral requirement, and blood transfusion were higher among nonsurvivors; however, a significant difference was achieved with the vasopressor need (p 0.001). Conclusion: This study demonstrated that the A–a gradient is a significant predictor of mortality in patients initiated on NIV for worsening respiratory distress in COVID pneumonia. All other ABG parameters also showed a significant AUC for predicting 28-day mortality, although with variable sensitivity and specificity.
机译：背景：肺泡 - 动脉氧（A-A）梯度测量肺泡和动脉系统的氧浓度之间的差异，具有相当大的临床效用。材料和方法：是一种回顾性的观察队列研究，涉及分析患有急性苍腹肺炎的患者，并在3个月内需要无侵入机械通气（NIV）。主要目的是研究A-A梯度（前NIV）的效用作为Covid肺炎28天死亡率的预测因子。二次目的包括其他动脉血气（ABG）参数（PRE-NIV）作为28天死亡率的预测的效用。还比较幸存者和非尿道之间的结果。通过接收器操作特征（ROC）曲线，YOEN指数和回归分析分析结果变量。结果：A-A梯度预测28天死亡率的最佳标准在0.5029的YENEN指数下计算为≤430.43，曲线（AUC）下的最高面积为0.755（P <0.0001）。关于回归分析，A-A梯度的差距为0.99。在非尿道VS幸存者中，在ABG预测因子中观察到在ABG预测因子中观察到显着差异，包括非尿患者VS幸存者（p值<0.001）。 VasoPressor要求需要肾脏替代疗法，肠胃外要求和输血中的肠胃药物的要求较高;然而，随着血管加压器的需求实现了显着的差异（P <0.001）。结论：本研究表明，A-A梯度是在核心肺炎呼吸窘迫恶化呼吸窘迫的患者中死亡率的显着预测因子。所有其他ABG参数还显示出用于预测28天死亡率的重要AUC，尽管具有可变的敏感性和特异性。

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