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Importance: The development and importance of ambulatory hypoxia in COVID-19 is unknown. The presence of ambulatory hypoxia may help risk-stratify hospitalized patients with COVID-19. If sufficient lead-time exists between development of ambulatory hypoxia and other outcome measures, interventions might be initiated earlier. Objective: To determine the association of ambulatory hypoxia with the eventual need for nasal cannula or advanced oxygenation therapies (defined as use of high flow nasal cannula, Bi-PAP, ventilator, or extracorporeal membrane oxygenation). Design: Retrospective, observational study of patients hospitalized with COVID-19 from March 1, 2020 to October 30, 2020. Setting: Ten hospitals in an integrated academic medical system (Northwestern Medicine) in the Chicagoland area. Participants: Adult patients (age > 18) hospitalized for COVID-19 who had ambulatory oximetry measured. Intervention(s) / Exposure(s): Ambulatory oximetry measurement. Main outcomes and measures: The association of ambulatory hypoxia with subsequent use of nasal cannula and advanced oxygen therapies and the time between ambulatory hypoxia and need for these oxygen therapies. Patients who had ambulatory oximetry measurements after use of nasal cannula or advanced oxygen therapies were excluded. Results: Of 531 patients with ambulatory oximetry measured, 132 (24.9%) had ambulatory hypoxia. Presence of ambulatory hypoxia was strongly associated with subsequent use of nasal cannula (OR 4.8, 95% CI 2.8 - 8.4) and advanced oxygen therapy (IRR 7.7, 95% CI 3.4 - 17.5). Ambulatory hypoxia measurement preceded nasal cannula use by a median 12.5 hours [IQR 3.25, 29.25] and advanced oxygenation therapies by 54 hours [IQR 25, 82]. Conclusion and Relevance: Ambulatory hypoxia is associated with moderate to severe COVID-19. It may serve as an early, non-invasive physiologic marker for the likelihood of developing moderate to severe disease and help clinicians triage patients and initiate earlier interventions.
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10.1101/2020.12.14.20248209
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document_parses/pdf_json/89127ef0ed88bf270ff4ac0795d1d494871ca485.json
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The Presence of Ambulatory Hypoxia as an Early Predictor of Moderate to Severe COVID-19 Disease
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