BMJ open · 2025
Prognostic value of the PaO2/FiO2 ratio for mortality in acute respiratory distress syndrome: a retrospective observational study in a lower-middle-income country.
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Luong Chinh Quoc, Dao Co Xuan, Nguyen My Ha, Pham Dung Thi, Pham Quynh Thi, Vu Tai Thien, Truong Hau Thi, Nguyen Hai Hoang, Nguyen Thao Thi Phuong, Luong Hoai Thi Thu, Nguyen Cuong Ba, Khuong Dai Quoc, Dang Hien Duy, Tran Cong Hong, Nguyen Tu Thanh, Nguyen Tuan Anh, Pham Thach The, Bui Giang Thi Huong, Bui Cuong Van, Nguyen Quan Huu, Tran Thong Huu, Nguyen Tan Cong, Vo Khoi Hong, Vu Lan Tuong, Phan Nga Thu, Nguyen Phuong Thi Ha, Nguyen Trong Dinh, Nguyen Cuong Duy, Nguyen Anh Dat, Nguyen Chi Van, Dang Tuan Quoc, Nguyen Binh Gia, Do Son Ngoc
Аннотация
OBJECTIVES: To evaluate the accuracy of the arterial oxygen partial pressure/inspired oxygen fraction (PaO2/FiO2) ratio in predicting mortality among acute respiratory distress syndrome (ARDS) patients in Vietnam.
DESIGN: A retrospective observational study.
SETTING: A central hospital in Vietnam.
PARTICIPANTS: Adult patients diagnosed with ARDS based on the Berlin definition and admitted to Bach Mai Hospital between August 2015 and August 2023. ARDS severity was converted from descriptive categories to the Berlin score, ranging from 1 (PaO2/FiO2>300 mm Hg) to 4 (PaO2/FiO2≤100 mm Hg).
PRIMARY OUTCOME: All-cause hospital mortality.
RESULTS: Of 345 patients, 67.5% were male, and the median age was 55.0 years (IQR: 39.0-66.0). Hospital mortality was 61.2% (211/345). On the first day of admission, the PaO2/FiO2 ratio (areas under the receiver operating characteristic curves (AUROC): 0.585 (95% CI 0.522 to 0.649)) showed limited predictive ability for hospital mortality. Incorporating the PaO2/FiO2 ratio into the Berlin score did not substantially improve accuracy (AUROC: 0.578 (95% CI 0.516 to 0.641)). Both measures were less accurate than Sequential Organ Failure Assessment (SOFA) (AUROC: 0.650 (95% CI 0.590 to 0.711)), Acute Physiology and Chronic Health Evaluation II (APACHE II) (AUROC: 0.685 (95% CI 0.628 to 0.742)) and Confusion, Urea >7 mmol/L (20 mg/dL), Respiratory rate ≥30 breaths/min, Blood pressure (systolic <90 mm Hg or diastolic ≤60 mm Hg) and Age ≥65 years (CURB-65) (AUROC: 0.689 (95% CI 0.617 to 0.762)). Higher PaO2/FiO2 values (adjusted OR, AOR: 0.988 (95% CI 0.979 to 0.996)) were independently associated with lower mortality risk, while higher Berlin (AOR: 2.477 (95% CI 1.190 to 5.156)), SOFA (AOR: 1.278 (95% CI 1.102 to 1.482)), APACHE II (AOR: 1.236 (95% CI 1.108 to 1.379)) and CURB-65 (AOR: 7.142 (95% CI 2.581 to 19.763)) scores were associated with increased mortality risk.
CONCLUSIONS: In this study of ARDS patients in Vietnam, the PaO2/FiO2 ratio demonstrated limited discriminatory ability for hospital mortality, and incorporating it into the Berlin score did not meaningfully improve performance. While less accurate than SOFA, APACHE II and CURB-65 scores, the PaO2/FiO2 ratio and Berlin score remained independently associated with mortality risk. These findings should be interpreted cautiously, given the retrospective design, single-centre setting and potential selection bias; further validation in larger, multicentre studies is warranted.
DESIGN: A retrospective observational study.
SETTING: A central hospital in Vietnam.
PARTICIPANTS: Adult patients diagnosed with ARDS based on the Berlin definition and admitted to Bach Mai Hospital between August 2015 and August 2023. ARDS severity was converted from descriptive categories to the Berlin score, ranging from 1 (PaO2/FiO2>300 mm Hg) to 4 (PaO2/FiO2≤100 mm Hg).
PRIMARY OUTCOME: All-cause hospital mortality.
RESULTS: Of 345 patients, 67.5% were male, and the median age was 55.0 years (IQR: 39.0-66.0). Hospital mortality was 61.2% (211/345). On the first day of admission, the PaO2/FiO2 ratio (areas under the receiver operating characteristic curves (AUROC): 0.585 (95% CI 0.522 to 0.649)) showed limited predictive ability for hospital mortality. Incorporating the PaO2/FiO2 ratio into the Berlin score did not substantially improve accuracy (AUROC: 0.578 (95% CI 0.516 to 0.641)). Both measures were less accurate than Sequential Organ Failure Assessment (SOFA) (AUROC: 0.650 (95% CI 0.590 to 0.711)), Acute Physiology and Chronic Health Evaluation II (APACHE II) (AUROC: 0.685 (95% CI 0.628 to 0.742)) and Confusion, Urea >7 mmol/L (20 mg/dL), Respiratory rate ≥30 breaths/min, Blood pressure (systolic <90 mm Hg or diastolic ≤60 mm Hg) and Age ≥65 years (CURB-65) (AUROC: 0.689 (95% CI 0.617 to 0.762)). Higher PaO2/FiO2 values (adjusted OR, AOR: 0.988 (95% CI 0.979 to 0.996)) were independently associated with lower mortality risk, while higher Berlin (AOR: 2.477 (95% CI 1.190 to 5.156)), SOFA (AOR: 1.278 (95% CI 1.102 to 1.482)), APACHE II (AOR: 1.236 (95% CI 1.108 to 1.379)) and CURB-65 (AOR: 7.142 (95% CI 2.581 to 19.763)) scores were associated with increased mortality risk.
CONCLUSIONS: In this study of ARDS patients in Vietnam, the PaO2/FiO2 ratio demonstrated limited discriminatory ability for hospital mortality, and incorporating it into the Berlin score did not meaningfully improve performance. While less accurate than SOFA, APACHE II and CURB-65 scores, the PaO2/FiO2 ratio and Berlin score remained independently associated with mortality risk. These findings should be interpreted cautiously, given the retrospective design, single-centre setting and potential selection bias; further validation in larger, multicentre studies is warranted.