• Aldo Bonaventura, Nicola Mumoli, Antonino Mazzone, Alessandra Colombo, Isabella Evangelista, Scilla Cerutti, Lorenza Brivio, Alessandra Vecchié, Alice Bonomi, Ombretta Para, Annamaria Bellizzi, Marco Cei, Patrizia Fenu, Flavio Tangianu, Francesco Dentali, and Francesco Cei.
• Medicina Generale 1, Medical Center, Department of Internal Medicine, Ospedale di Circolo e Fondazione Macchi, ASST Sette Laghi, Varese, Italy. aldo.bonaventura@asst-settelaghi.it.
• Intern Emerg Med. 2022 Sep 1; 17 (6): 1769-1775.

AbstractSome patients affected by severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) experience acute hypoxemic respiratory failure progressing toward atypical acute respiratory distress syndrome (ARDS). The aim of the study is to evaluate whether a correlation between ratio of peripheral saturation of oxygen (SpO2) and fraction of inspired oxygen (S/F) and ratio of arterial partial pressure of oxygen and fraction of inspired oxygen (P/F) exists in COVID-19-related ARDS as already known in classical ARDS. In this multicenter, retrospective, observational study, consecutive, adult (≥ 18 years) patients with symptomatic coronavirus disease 2019 (COVID-19) admitted to different COVID-19 divisions in Italy between March and December 2020 were included. Patients with SpO2 > 97% or missing information were excluded. We included 1,028 patients (median age 72 years, prevalence of males [62.2%]). A positive correlation was found between P/F and S/F (r = 0.938, p < 0.0001). A receiver operating characteristic (ROC) curve analysis showed that S/F accurately recognizes the presence of ARDS (P/F ≤ 300 mmHg) in COVID-19 patients, with a cut-off of ≤ 433% showing good sensitivity and specificity. S/F was also tested against P/F values ≤ 200 and ≤ 100 mmHg (suggestive for moderate and severe ARDS, respectively), the latter showing great accuracy for S/F ≤ 178%. S/F was accurate in predicting ARDS for SpO2 ≥ 92%. In conclusion, our findings support the routine use of S/F as a reliable surrogate of P/F in patients with COVID-19-related ARDS.© 2022. The Author(s), under exclusive licence to Società Italiana di Medicina Interna (SIMI).

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