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Optimal Cutoffs for the Ratio of Arterial Oxygen Partial Pressure to Inspired Oxygen Fraction in Categorizing Respiratory Impairment Severity in Organ Failure Scores

2026-01-01Artigo científico Acesso aberto
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dc.contributor.authorPölkki, Anssi
dc.contributor.authorReinikainen, Matti
dc.contributor.authorRochwerg, Bram
dc.contributor.authorJung, Christian
dc.contributor.authorSendagire, Cornelius
dc.contributor.authorChaudhuri, Dipayan
dc.contributor.authorMartin, Greg S.
dc.contributor.authorSelander, Tuomas
dc.contributor.authorRhodes, Andrew
dc.contributor.authorMoreno, Rui
dc.contributor.authorMoreno, Rui
dc.contributor.authorSinger, Mervyn
dc.contributor.authorLaffey, John G.
dc.contributor.authorPekkarinen, Pirkka T.
dc.contributor.institutionNOVA Medical School|Faculdade de Ciências Médicas (NMS|FCM)
dc.contributor.pblBlackwell Munksgaard
dc.date.accessioned2025-12-04T21:16:45Z
dc.date.available2025-12-04T21:16:45Z
dc.date.issued2026-01-01
dc.descriptionPublisher Copyright: © 2025 The Author(s). Acta Anaesthesiologica Scandinavica published by John Wiley & Sons Ltd on behalf of Acta Anaesthesiologica Scandinavica Foundation.
dc.description.abstractBACKGROUND: The ratio of arterial oxygen partial pressure to fraction of inspired oxygen (PaO2/FiO2, hereafter P/F ratio) is a key component of the Sequential Organ Failure Assessment (SOFA) score. It reflects the severity of hypoxaemic respiratory failure. The ongoing revision of the SOFA score requires data-driven cutoffs for P/F ratio as well as rational criteria for respiratory support. In this study, we aimed to determine the optimal P/F ratio cutoffs for determining respiratory failure categories in the revised SOFA score and examined whether advanced respiratory support should be a prerequisite for the most severe categories. METHODS: We used the database of the intensive care unit of Kuopio University Hospital, Finland, for cutoff derivation and the eICU database, a multicenter U.S. intensive care registry, for external validation. We identified cutoffs most discriminative for hospital mortality using the log-rank statistic test with the Contal and O'Quigley method. In external validation, these cutoffs were compared with those in the current respiratory SOFA score. RESULTS: Optimal cutoffs were identified as follows: P/F ratio > 40 kPa (normal), 30-40 kPa (mild impairment), 20-30 kPa (moderate impairment), 10-20 kPa (severe impairment), and ≤ 10 kPa (critical impairment). These cutoffs resulted in clear separation of the severity categories (chi-square for log-rank statistic 356.9). They outperformed the current respiratory SOFA score cutoffs in the validation cohort (AUROC 0.615, 95% CI 0.607-0.622 vs. AUROC 0.610, 95% CI 0.603-0.618, p < 0.001). Advanced respiratory support was associated with higher mortality, but its inclusion as a prerequisite improved discrimination only in the moderately impaired respiratory function category, not in the severely or critically impaired categories. CONCLUSION: P/F ratio cutoffs using 10 kPa (75 mmHg) intervals were identified to be optimal for distinguishing stages of respiratory failure severity. The impact of respiratory support on P/F ratio-mortality associations suggests the need to calibrate any P/F ratio-based score by support level, but optimal calibration methods require further study. EDITORIAL COMMENT: In this study, the cut-off values for the partial pressure of arterial oxygen to the fraction of inspired oxygen (P/F ratio) were investigated in a large Finnish intensive care database and validated externally with the US intensive care registry. The aim was to support a revision of the cut-off values for the P/F ratio in the Sequential Organ Failure Assessment (SOFA) score. The results showed that incremental changes in the P/F ratio of 10 kPa are better than 13 kPa and emphasize the need for critical assessment of the current SOFA score.en
dc.description.versionpublishersversion
dc.description.versionpublished
dc.format.extent567654
dc.identifier.doi10.1111/aas.70137
dc.identifier.issn0001-5172
dc.identifier.otherPURE: 135034991
dc.identifier.otherPURE UUID: a5bf52ad-9649-49bd-a27e-09ddd53cd08f
dc.identifier.otherScopus: 105020351914
dc.identifier.otherPubMed: 41160043
dc.identifier.urihttp://hdl.handle.net/10362/191503
dc.identifier.urlhttps://www.scopus.com/pages/publications/105020351914
dc.language.isoeng
dc.peerreviewedyes
dc.subjectAnesthesiology and Pain Medicine
dc.titleOptimal Cutoffs for the Ratio of Arterial Oxygen Partial Pressure to Inspired Oxygen Fraction in Categorizing Respiratory Impairment Severity in Organ Failure Scoresen
dc.typejournal article
degois.publication.firstPage
degois.publication.issue1
degois.publication.lastPage
degois.publication.titleActa Anaesthesiologica Scandinavica
degois.publication.volume70
dspace.entity.typePublication
person.familyNameMoreno
person.givenNameRui
person.identifier.orcid0000-0002-9795-8316
rcaap.rightsopenAccess
relation.isAuthorOfPublication66827ae5-eb00-4c24-a932-9da3bb79b461
relation.isAuthorOfPublication.latestForDiscovery66827ae5-eb00-4c24-a932-9da3bb79b461

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