Abstract
Background: We aimed to assess whether asymptomatic (“happy”) hypoxia was an identifiable physiological phenotype of COVID-19 acute respiratory distress syndrome (ARDS), and associated with need for ICU admission.
Methods: We performed an observational cohort study of all adult patients admitted with hypoxaemic respiratory failure to a large acute hospital Trust serving the East Midlands, UK. Patients with confirmed COVID-19 were compared to those without. Physiological response to hypoxaemia was modelled using a linear mixed effects model.
Results: Of 1,586 patients included, 75% tested positive for SARS-CoV-2. The ROX index was 2.08 min -1 lower (1.56-2.61, p < 0.001) in the COVID-19 cohort when adjusted for age and ethnicity, suggesting an enhanced respiratory response to hypoxia compared to the non-Covid-19 patients. There was substantial residual inter- and intra-patient variability in the respiratory response to hypoxaemia. 33% of the infected cohort required ICU, and of these 31% died within 60 days. ICU admission and mortality were both associated with an enhanced respiratory response for all degrees of hypoxaemia.
Conclusions: Patients with COVID-19 display a more symptomatic phenotype in response to hypoxaemia than those with other causes of hypoxaemic respiratory failure, however individual patients exhibit a wide range of responses. As such although asymptomatic hypoxaemia may be a phenomenon in any individual patient with hypoxaemic respiratory failure, it is no more frequently observed in those with SARS-CoV-2 infection than without.
Keywords: ARDS; COVID-19; Clinical deterioration; Hypoxaemia.
【저자키워드】 COVID-19, ARDS, hypoxaemia, Clinical deterioration, 【초록키워드】 SARS-CoV-2, Mortality, hypoxia, SARS-COV-2 infection, hospital, ICU, Cohort, Asymptomatic, symptomatic, clinical, Patient, ICU admission, phenotype, hypoxaemia, age, Trust, patients, acute respiratory distress, physiological, ROX index, Observational cohort study, Variability, syndrome, hypoxaemic respiratory failure, positive, East, COVID-19 cohort, Effect, responses, tested, performed, died, required, linear, adjusted, cause, with COVID-19, 【제목키워드】 hypoxia, Infection, characteristic, patients with COVID-19,