Prognostic value of the PaO2/FiO2 ratio for mortality in acute respiratory distress syndrome: a retrospective observational study in a lower-middle-income country.
| Title: | Prognostic value of the PaO2/FiO2 ratio for mortality in acute respiratory distress syndrome: a retrospective observational study in a lower-middle-income country. |
|---|---|
| Authors: | Luong CQ; Neuro Intensive Care Department, National Institute of Neuroscience, Bach Mai Hospital, Hanoi, Viet Nam.; Department of Emergency and Critical Care Medicine, Hanoi Medical University, Hanoi, Viet Nam.; Department of Emergency and Critical Care Medicine, Faculty of Medicine, VNU University of Medicine and Pharmacy, Vietnam National University, Hanoi, Viet Nam.; Dao CX; Department of Emergency and Critical Care Medicine, Hanoi Medical University, Hanoi, Viet Nam.; Department of Emergency and Critical Care Medicine, Faculty of Medicine, VNU University of Medicine and Pharmacy, Vietnam National University, Hanoi, Viet Nam.; Center for Critical Care Medicine, Bach Mai Hospital, Hanoi, Viet Nam.; Nguyen MH; Department of Health Organization and Management, Faculty of Public Health, Thai Binh University of Medicine and Pharmacy, Hung Yen, Viet Nam.; Pham DT; Department of Nutrition and Food Safety, Faculty of Public Health, Thai Binh University of Medicine and Pharmacy, Hung Yen, Viet Nam.; Pham QT; Department of Emergency and Critical Care Medicine, Hanoi Medical University, Hanoi, Viet Nam.; Intensive Care Unit, University Medical Center Ho Chi Minh City, University of Medicine and Pharmacy at Ho Chi Minh City, Ho Chi Minh City, Viet Nam.; Vu TT; Department of Emergency and Critical Care Medicine, Hanoi Medical University, Hanoi, Viet Nam.; Emergency Department, Thai Nguyen National Hospital, Thai Nguyen, Viet Nam.; Truong HT; Department of Emergency and Critical Care Medicine, Hanoi Medical University, Hanoi, Viet Nam.; Center for Critical Care Medicine, Bach Mai Hospital, Hanoi, Viet Nam.; Stroke Center, Bach Mai Hospital, Hanoi, Viet Nam.; Nguyen HH; Neuro Intensive Care Department, National Institute of Neuroscience, Bach Mai Hospital, Hanoi, Viet Nam.; Department of Emergency and Critical Care Medicine, Hanoi Medical University, Hanoi, Viet Nam.; Emergency Department, Agriculture General Hospital, Hanoi, Viet Nam.; Nguyen TTP; Neuro Intensive Care Department, National Institute of Neuroscience, Bach Mai Hospital, Hanoi, Viet Nam.; Department of Emergency and Critical Care Medicine, Hanoi Medical University, Hanoi, Viet Nam.; Center for Emergency Medicine, Bach Mai Hospital, Hanoi, Viet Nam.; Luong HTT; Department of Emergency and Critical Care Medicine, Hanoi Medical University, Hanoi, Viet Nam.; Department of Family Medicine, University of Medicine and Pharmacy, Thai Nguyen University, Thai Nguyen, Viet Nam.; Nguyen CB; Center for Critical Care Medicine, Bach Mai Hospital, Hanoi, Viet Nam.; Khuong DQ; Department of Emergency and Critical Care Medicine, Hanoi Medical University, Hanoi, Viet Nam.; Center for Emergency Medicine, Bach Mai Hospital, Hanoi, Viet Nam.; Dang HD; Department of Emergency and Critical Care Medicine, Faculty of Medicine, VNU University of Medicine and Pharmacy, Vietnam National University, Hanoi, Viet Nam.; Center for Critical Care Medicine, Bach Mai Hospital, Hanoi, Viet Nam.; Tran CH; Department of Emergency and Critical Care Medicine, Faculty of Medicine, VNU University of Medicine and Pharmacy, Vietnam National University, Hanoi, Viet Nam.; Center for Emergency Medicine, Bach Mai Hospital, Hanoi, Viet Nam.; Nguyen TT; Department of Emergency and Critical Care Medicine, Faculty of Medicine, VNU University of Medicine and Pharmacy, Vietnam National University, Hanoi, Viet Nam.; Center for Emergency Medicine, Bach Mai Hospital, Hanoi, Viet Nam.; Nguyen TA; Department of Emergency and Critical Care Medicine, Hanoi Medical University, Hanoi, Viet Nam.; Center for Emergency Medicine, Bach Mai Hospital, Hanoi, Viet Nam.; Pham TT; Department of Emergency and Critical Care Medicine, Hanoi Medical University, Hanoi, Viet Nam.; Department of Emergency and Critical Care Medicine, Faculty of Medicine, VNU University of Medicine and Pharmacy, Vietnam National University, Hanoi, Viet Nam.; Center for Critical Care Medicine, Bach Mai Hospital, Hanoi, Viet Nam.; Bui GTH; Department of Emergency and Critical Care Medicine, Hanoi Medical University, Hanoi, Viet Nam.; Center for Critical Care Medicine, Bach Mai Hospital, Hanoi, Viet Nam.; Bui CV; Department of Emergency and Critical Care Medicine, Hanoi Medical University, Hanoi, Viet Nam.; Department of Emergency and Critical Care Medicine, Faculty of Medicine, VNU University of Medicine and Pharmacy, Vietnam National University, Hanoi, Viet Nam.; Department of Intensive Care for Tropical Diseases, Bach Mai Institute for Tropical Medicine, Bach Mai Hospital, Hanoi, Viet Nam.; Nguyen QH; Department of Emergency and Critical Care Medicine, Hanoi Medical University, Hanoi, Viet Nam.; Department of Emergency and Critical Care Medicine, Faculty of Medicine, VNU University of Medicine and Pharmacy, Vietnam National University, Hanoi, Viet Nam.; Center for Emergency Medicine, Bach Mai Hospital, Hanoi, Viet Nam.; Tran TH; Department of Emergency and Critical Care Medicine, Hanoi Medical University, Hanoi, Viet Nam.; Department of Emergency and Critical Care Medicine, Faculty of Medicine, VNU University of Medicine and Pharmacy, Vietnam National University, Hanoi, Viet Nam.; Center for Emergency Medicine, Bach Mai Hospital, Hanoi, Viet Nam.; Nguyen TC; Department of Emergency and Critical Care Medicine, Hanoi Medical University, Hanoi, Viet Nam.; Department of Emergency and Critical Care Medicine, Faculty of Medicine, VNU University of Medicine and Pharmacy, Vietnam National University, Hanoi, Viet Nam.; Center for Critical Care Medicine, Bach Mai Hospital, Hanoi, Viet Nam.; Vo KH; Emergency Neurology Room, National Institute of Neuroscience, Bach Mai Hospital, Hanoi, Viet Nam.; Department of Neurology, Hanoi Medical University, Hanoi, Viet Nam.; Department of Neurology, Faculty of Medicine, VNU University of Medicine and Pharmacy, Vietnam National University, Hanoi, Viet Nam.; Vu LT; Department of Emergency and Critical Care Medicine, Hanoi Medical University, Hanoi, Viet Nam.; Center for Emergency Medicine, Bach Mai Hospital, Hanoi, Viet Nam.; Phan NT; Department of Health Organization and Management, Faculty of Public Health, Thai Binh University of Medicine and Pharmacy, Hung Yen, Viet Nam.; Nguyen PTH; Department of Health Sociology, Faculty of Public Health, Thai Binh University of Medicine and Pharmacy, Hung Yen, Viet Nam.; Nguyen TD; Thai Binh Medical College Hospital, Thai Binh Medical College, Hung Yen, Viet Nam.; Nguyen CD; Department of Emergency and Critical Care Medicine, Thai Binh University of Medicine and Pharmacy, Hung Yen, Viet Nam.; Nguyen AD; Department of Emergency and Critical Care Medicine, Hanoi Medical University, Hanoi, Viet Nam.; Center for Emergency Medicine, Bach Mai Hospital, Hanoi, Viet Nam.; Nguyen CV; Department of Emergency and Critical Care Medicine, Hanoi Medical University, Hanoi, Viet Nam.; Center for Emergency Medicine, Bach Mai Hospital, Hanoi, Viet Nam.; Dang TQ; Department of Emergency and Critical Care Medicine, Hanoi Medical University, Hanoi, Viet Nam.; Center for Critical Care Medicine, Bach Mai Hospital, Hanoi, Viet Nam.; Nguyen BG; Center for Critical Care Medicine, Bach Mai Hospital, Hanoi, Viet Nam.; Department of Pre-Hospital Emergency Medicine, Faculty of Medicine, VNU University of Medicine and Pharmacy, Vietnam National University, Hanoi, Viet Nam.; Do SN; Department of Emergency and Critical Care Medicine, Hanoi Medical University, Hanoi, Viet Nam sonngocdo@gmail.com.; Department of Emergency and Critical Care Medicine, Faculty of Medicine, VNU University of Medicine and Pharmacy, Vietnam National University, Hanoi, Viet Nam.; Center for Critical Care Medicine, Bach Mai Hospital, Hanoi, Viet Nam. |
| Source: | BMJ open [BMJ Open] 2025 Dec 17; Vol. 15 (12), pp. e100589. Date of Electronic Publication: 2025 Dec 17. |
| Publication Type: | Journal Article; Observational Study |
| Language: | English |
| Journal Info: | Publisher: BMJ Publishing Group Ltd Country of Publication: England NLM ID: 101552874 Publication Model: Electronic Cited Medium: Internet ISSN: 2044-6055 (Electronic) Linking ISSN: 20446055 NLM ISO Abbreviation: BMJ Open Subsets: MEDLINE |
| Imprint Name(s): | Original Publication: [London] : BMJ Publishing Group Ltd, 2011- |
| MeSH Terms: | Respiratory Distress Syndrome*/mortality ; Respiratory Distress Syndrome*/blood ; Oxygen*/blood ; Hospital Mortality*; Vietnam/epidemiology ; Humans ; Male ; Female ; Retrospective Studies ; Middle Aged ; Prognosis ; Aged ; Adult ; Blood Gas Analysis ; Partial Pressure ; Severity of Illness Index ; ROC Curve ; Predictive Value of Tests |
| Abstract: | Objectives: To evaluate the accuracy of the arterial oxygen partial pressure/inspired oxygen fraction (PaO2/FiO2) ratio in predicting mortality among acute respiratory distress syndrome (ARDS) patients in Vietnam.; Design: A retrospective observational study.; Setting: A central hospital in Vietnam.; Participants: Adult patients diagnosed with ARDS based on the Berlin definition and admitted to Bach Mai Hospital between August 2015 and August 2023. ARDS severity was converted from descriptive categories to the Berlin score, ranging from 1 (PaO2/FiO2>300 mm Hg) to 4 (PaO2/FiO2≤100 mm Hg).; Primary Outcome: All-cause hospital mortality.; Results: Of 345 patients, 67.5% were male, and the median age was 55.0 years (IQR: 39.0-66.0). Hospital mortality was 61.2% (211/345). On the first day of admission, the PaO2/FiO2 ratio (areas under the receiver operating characteristic curves (AUROC): 0.585 (95% CI 0.522 to 0.649)) showed limited predictive ability for hospital mortality. Incorporating the PaO2/FiO2 ratio into the Berlin score did not substantially improve accuracy (AUROC: 0.578 (95% CI 0.516 to 0.641)). Both measures were less accurate than Sequential Organ Failure Assessment (SOFA) (AUROC: 0.650 (95% CI 0.590 to 0.711)), Acute Physiology and Chronic Health Evaluation II (APACHE II) (AUROC: 0.685 (95% CI 0.628 to 0.742)) and Confusion, Urea >7 mmol/L (20 mg/dL), Respiratory rate ≥30 breaths/min, Blood pressure (systolic |
| Competing Interests: | Competing interests: None declared. |
| References: | J Med Assoc Thai. 2014 Jan;97 Suppl 1:S61-8. (PMID: 24855844); Chest. 2007 Aug;132(2):410-7. (PMID: 17573487); JAMA. 2016 Feb 23;315(8):788-800. (PMID: 26903337); Intensive Care Med. 2014 Jan;40(1):74-83. (PMID: 24170143); Am J Emerg Med. 2021 Jun;44:352-357. (PMID: 32331955); Sci Rep. 2021 Apr 1;11(1):7334. (PMID: 33795768); Intensive Care Med. 2011 Dec;37(12):1932-41. (PMID: 21997128); BMC Infect Dis. 2023 May 9;23(1):311. (PMID: 37161412); Sci Rep. 2021 Sep 23;11(1):18924. (PMID: 34556710); Intensive Care Med. 2014 Mar;40(3):388-96. (PMID: 24435201); BMJ Open. 2024 Dec 9;14(12):e085971. (PMID: 39653572); Clin Infect Dis. 2016 Sep 1;63(5):e61-e111. (PMID: 27418577); Heart. 2014 Feb;100(4):288-94. (PMID: 24186563); Eur J Intern Med. 2021 Oct;92:48-54. (PMID: 34175182); PLoS One. 2019 Aug 15;14(8):e0221114. (PMID: 31415662); JAMA. 2016 Feb 23;315(8):801-10. (PMID: 26903338); Lancet. 1967 Aug 12;2(7511):319-23. (PMID: 4143721); Am J Gastroenterol. 2006 Oct;101(10):2379-400. (PMID: 17032204); Thorax. 2003 May;58(5):377-82. (PMID: 12728155); J Crit Care. 2017 Dec;42:109-115. (PMID: 28711861); Intensive Care Med. 2023 Jul;49(7):727-759. (PMID: 37326646); PLoS One. 2023 Mar 1;18(3):e0279935. (PMID: 36857362); Can Respir J. 2022 Mar 28;2022:5129314. (PMID: 35356088); J Allergy Clin Immunol. 2020 Oct;146(4):799-807.e9. (PMID: 32710975); Am Rev Respir Dis. 1985 Sep;132(3):485-9. (PMID: 4037521); Am J Epidemiol. 2011 Mar 15;173(6):676-82. (PMID: 21330339); Postgrad Med J. 2022 Nov 1;98(1165):871-879. (PMID: 37063032); PLoS One. 2020 Dec 31;15(12):e0244628. (PMID: 33382773); J Chronic Dis. 1987;40(5):373-83. (PMID: 3558716); Intensive Care Med. 2000 Dec;26(12):1779-85. (PMID: 11271085); Crit Care Med. 2016 Jan;44(1):120-9. (PMID: 26474112); Am J Respir Crit Care Med. 2024 Jan 1;209(1):37-47. (PMID: 37487152); Am Rev Respir Dis. 1988 Sep;138(3):720-3. (PMID: 3202424); Eur Respir J. 2020 Sep 10;56(3):. (PMID: 32675205); Chest. 2022 Apr;161(4):927-936. (PMID: 34740594); Crit Care Med. 2005 Jun;33(6):1191-8. (PMID: 15942330); Crit Care Med. 1985 Oct;13(10):818-29. (PMID: 3928249); Prehosp Emerg Care. 2012 Jul-Sep;16(3):381-9. (PMID: 22490009); Eur Respir J. 2021 Mar 25;57(3):. (PMID: 33767005); Sci Rep. 2025 Mar 03;15(1):7406. (PMID: 40033012); Am J Trop Med Hyg. 2021 May 03;105(1):73-80. (PMID: 33939645); Intensive Care Med. 2016 Dec;42(12):1865-1876. (PMID: 27757516); Chest. 2016 Aug;150(2):307-13. (PMID: 26836924); BMC Pulm Med. 2019 Feb 11;19(1):37. (PMID: 30744598); Intensive Care Med. 2012 Oct;38(10):1573-82. (PMID: 22926653); Intensive Care Med. 1994;20(3):225-32. (PMID: 8014293); Lancet Respir Med. 2022 Nov;10(11):1086-1098. (PMID: 36049490); Przegl Epidemiol. 2016;70(1):15-20, 107-10. (PMID: 27344468); JAMA. 2012 Jun 20;307(23):2526-33. (PMID: 22797452); BMC Pulm Med. 2022 Jul 11;22(1):268. (PMID: 35820835); Intern Med. 2012;51(14):1835-40. (PMID: 22821096); Crit Care Med. 2017 Aug;45(8):1317-1324. (PMID: 28538439); Am J Respir Crit Care Med. 2017 May 1;195(9):1253-1263. (PMID: 28459336); Am J Respir Crit Care Med. 2022 Feb 1;205(3):364-366. (PMID: 34874819); Chest. 2017 Dec;152(6):1151-1158. (PMID: 28823812); Anesthesiology. 2019 Feb;130(2):263-283. (PMID: 30499850); Eur Respir J. 2019 Oct 17;54(4):. (PMID: 31346004); Intern Med. 2025 Jul 1;64(13):1955-1964. (PMID: 39631866); Environ Health Prev Med. 2017 Oct 30;22(1):74. (PMID: 29165160); Intensive Care Med. 1996 Jul;22(7):707-10. (PMID: 8844239); Intensive Care Med. 2013 Dec;39(12):2161-70. (PMID: 24114319) |
| Contributed Indexing: | Keywords: ACCIDENT & EMERGENCY MEDICINE; Adult intensive & critical care; INTENSIVE & CRITICAL CARE; Intensive Care Units; Mortality |
| Substance Nomenclature: | S88TT14065 (Oxygen) |
| Entry Date(s): | Date Created: 20251217 Date Completed: 20251217 Latest Revision: 20260106 |
| Update Code: | 20260130 |
| PubMed Central ID: | PMC12716528 |
| DOI: | 10.1136/bmjopen-2025-100589 |
| PMID: | 41407421 |
| Database: | MEDLINE |
Journal Article; Observational Study