The association between high-oxygen saturation and prognosis for intracerebral hemorrhage

Concerns about the adverse effects of excessive oxygen have grown over the years. This study investigated the relationship between high oxygen saturation and short-term prognosis of patients with spontaneous intracerebral hemorrhage (sICH) after liberal use of oxygen.

This retrospective cohort study collected data from the Medical Information Mart for Intensive Care III (MIMIC-III) database (ICU cohort) and a tertiary stroke center (general ward cohort). The data on pulse oximetry-derived oxygen saturation (SpO₂) during the first 24 h in ICU and general wards were respectively extracted.

Overall, 1117 and 372 patients were included in the ICU and general ward cohort, respectively. Among the patients from the ICU cohort, a spoon-shaped association was observed between minimum SpO₂ and the risk of in-hospital mortality (non-linear P<0.0001). In comparison with minimum SpO₂ of 93-97%, the minimum SpO₂>97% was associated with a significantly higher risk of in-hospital mortality after adjustment for confounders. Sensitivity analysis conducted using propensity score matching did not change this significance. The same spoon-shaped association between minimum SpO₂ and the risk of in-hospital mortality was also detected for the general ward cohort. In comparison with the group with 95-97% SpO₂, the group with SpO₂>97% showed a stronger association with, but non-significant risk for, in-hospital mortality after adjustment for confounders. The time-weighted average SpO₂>97% was associated significantly with in-hospital mortality in both cohorts.

Higher SpO₂ (especially a minimum SpO₂>97%) was unrewarding after liberal use of oxygen among patients with sICH and might even be potentially detrimental.