Continuous Monitoring Enables Dynamic Biomarkers to Assess Resilience in Acute COVID-19 Patients

Background/Objectives: The effective management of acute illnesses like COVID-19 requires tools to dynamically assess a patient's resilience to health stressors. This study evaluates novel dynamic biomarkers from continuous blood oxygen saturation (SpO₂) monitoring, exploring their association with patient outcomes to support clinical decision making. Methods: We examined 200 hospital admissions from 181 adults diagnosed with COVID-19. Two dynamic biomarkers reflecting the homeostatic regulation efficiency of SpO₂ were developed to assess their association with adverse hospital outcomes, specifically ICU admission or death, using binary logistic regressions. The resilience exponent α recorded the relative frequency of prolonged SpO₂ declines, while O₂ challenges quantified the dynamic response to changes in O₂ supplementation. Results: Increased resilience exponent α corresponded to decreased odds of adverse outcomes (OR [95% CI] = 0.59 [0.37-0.93], p = 0.03). Larger SpO₂ increases in response to O₂ supplementation were associated with increased odds of adverse outcomes (OR [95% CI] = 1.40 [1.04-1.83], p = 0.03). Additionally, the number of O₂ supplementation increases (OR [95% CI] = 2.91 [1.90-4.49]) and decreases (OR [95% CI] = 0.33 [0.20-0.55]) during hospitalization were independently linked to poorer and improved outcomes, respectively (both p < 0.001). Conclusions: The resilience exponent α and the O₂ challenge response provide insights into the dynamic regulation of SpO₂, reflecting physical resilience in COVID-19 patients. Continuous SpO₂ monitoring in acute care settings could support more informed clinical decisions during patient management.