Association between arterial oxygen and mortality across critically ill patients with hematologic malignancies: results from an international collaborative network

期刊论文
发表日期：

2024年4月10日

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Guillaume Dumas,
Idunn S. Morris,
Tamishta Hensman,
Sean M. Bagshaw,
Alexandre Demoule,
Bruno L. Ferreyro,
Achille Kouatchet,
Virginie Lemiale,
Djamel Mokart,
Frédéric Pène,
Sangeeta Mehta,
Elie Azoulay,
Laveena Munshi,
Laurent Argaud,
François Barbier,
Dominique Benoit,
Naike Bigé,
Fabrice Bruneel,
Emmanuel Canet,
Yves Cohen,
Michael Darmon,
Didier Gruson,
Kada Klouche,
Loay Kontar,
Alexandre Lautrette,
Christine Lebert,
Guillaume Louis,
Julien Mayaux,
Anne-Pascale Meert,
Anne-Sophie Moreau,
Martine Nyunga,
Vincent Peigne,
Pierre Perez,
Jean-Herlé Raphalen,
Carole Schwebel,
Jean-Marie Tonnelier,
Florent Wallet,
Lara Zafrani,
Bram Rochwerg,
Farah Shoukat,
Dean Fergusson,
Bruno Ferreyro,
Paul Heffernan,
Margaret Herridge,
Sheldon Magder,
Mark Minden,
Rakesh Patel,
Salman Qureshi,
Aaron Schimmer,
Santhosh Thyagu,
Han Ting Wang,
Sangeeta Mehta,
Sean M. Bagshaw

摘要

Purpose

Patients with hematological malignancies are at high risk for life-threatening complications. To date, little attention has been paid to the impact of hyperoxemia and excess oxygen use on mortality. The aim of this study was to investigate the association between partial pressure of arterial oxygen (PaO₂) and 28-day mortality in critically ill patients with hematologic malignancies.

Methods

Data from three international cohorts (Europe, Canada, Oceania) of patients who received respiratory support (noninvasive ventilation, high-flow nasal cannula, invasive mechanical ventilation) were obtained. We used mixed-effect Cox models to investigate the association between day one PaO₂ or excess oxygen use (inspired fraction of oxygen ≥ 0.6 with PaO₂ > 100 mmHg) on day-28 mortality.

Results

11,249 patients were included. On day one, 5716 patients (50.8%) had normoxemia (60 ≤ PaO₂ ≤ 100 mmHg), 1454 (12.9%) hypoxemia (PaO₂ < 60 mmHg), and 4079 patients (36.3%) hyperoxemia (PaO₂ > 100 mmHg). Excess oxygen was used in 2201 patients (20%). Crude day-28 mortality rate was 40.6%. There was a significant association between PaO₂ and day-28 mortality with a U-shaped relationship (p < 0.001). Higher PaO₂ levels (> 100 mmHg) were associated with day-28 mortality with a dose–effect relationship. Subgroup analyses showed an association between hyperoxemia and mortality in patients admitted with neurological disorders; however, the opposite relationship was seen across those admitted with sepsis and neutropenia. Excess oxygen use was also associated with subsequent day-28 mortality (adjusted hazard ratio (aHR) [95% confidence interval (CI)]: 1.11[1.04–1.19]). This result persisted after propensity score analysis (matched HR associated with excess oxygen:1.31 [1.20–1.1.44]).

Conclusion

In critically-ill patients with hematological malignancies, exposure to hyperoxemia and excess oxygen use were associated with increased mortality, with variable magnitude across subgroups. This might be a modifiable factor to improve mortality.