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The PaO2/FiO2 is independently associated with 28-day mortality in patients with sepsis: a retrospective analysis

Hongying Bi1, Xu Liu2, Chi Chen3

  • 1Department of Critical Care Medicine, The Affiliated Hospital of Guizhou Medical University, Guiyang, Guizhou, China.

BMC Pulmonary Medicine
|May 27, 2023
PubMed
Abstract

Insights

Both low and high arterial oxygen tension/inspired oxygen fraction (PaO2/FiO2) ratios are linked to increased 28-day mortality in sepsis patients. An optimal PaO2/FiO2 range exists, below which mortality risk rises.

Area of Science:

  • Critical Care Medicine
  • Respiratory Physiology
  • Sepsis Pathophysiology

Background:

  • Sepsis is a life-threatening organ dysfunction caused by a dysregulated host response to infection.
  • The PaO2/FiO2 ratio is a key indicator of oxygenation status in critically ill patients.
  • The precise relationship between PaO2/FiO2 and mortality in sepsis remains incompletely understood.

Purpose of the Study:

  • To investigate the association between the PaO2/FiO2 ratio and 28-day mortality in patients diagnosed with sepsis.
  • To identify potential thresholds of PaO2/FiO2 that may predict mortality risk.

Main Methods:

  • Retrospective cohort study utilizing the MIMIC-IV database.
  • Included 19,233 patients with sepsis, analyzing PaO2/FiO2 as the exposure and 28-day mortality as the outcome.
  • Employed generalized additive models and a two-piecewise linear model to assess the non-linear relationship and identify an inflection point.

Main Results:

  • A U-shaped relationship was observed between the log-transformed PaO2/FiO2 (LnPaO2/FiO2) and 28-day mortality.
  • An inflection point for PaO2/FiO2 was identified at 200.33 mmHg.
  • Below this threshold, lower PaO2/FiO2 was associated with increased mortality (OR 0.37); above it, higher PaO2/FiO2 was also associated with increased mortality (OR 1.53).

Conclusions:

  • Both excessively low and high PaO2/FiO2 levels are independently associated with increased 28-day mortality in sepsis patients.
  • A narrow range of PaO2/FiO2 (approximately 183-219 mmHg) appears to be associated with the lowest risk of 28-day mortality.
  • These findings suggest a potential therapeutic window for optimizing oxygenation in sepsis management.
Keywords:
28-day mortalityMIMIC-IV databasePaO2/FiO2Sepsis

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