• Giulio Cassano, Giovanni Nattino, Mauro Belotti, Francesca Cortellaro, Roberto Cosentini, Giulia Irene Ghilardi, Marco Paganuzzi, Stefano Paglia, Carlotta Rossi, Monica Solbiati, Guido Bertolini, Anna Maria Brambilla, and FENICE Network.
• Emergency Medicine Unit, Luigi Sacco Hospital, ASST FBF Sacco, Milan, Italy.
• Intern Emerg Med. 2023 Oct 1; 18 (7): 207520822075-2082.

AbstractWhile several studies have evaluated the prognostic weight of respiratory parameters in patients with COVID-19, few have focused on patients' clinical conditions at the first emergency department (ED) assessment. We analyzed a large cohort of ED patients recruited within the EC-COVID study over the year 2020, and assessed the association between key bedside respiratory parameters measured in room air (pO2, pCO2, pH, and respiratory rate [RR]) and hospital mortality, after adjusting for key confounding factors. Analyses were based on a multivariable logistic Generalized Additive Model (GAM). After excluding patients who did not perform a blood gas analysis (BGA) test in room air or with incomplete BGA results, a total of 2458 patients were considered in the analyses. Most patients were hospitalized on ED discharge (72.0%); hospital mortality was 14.3%. Strong, negative associations with hospital mortality emerged for pO2, pCO2 and pH (p-values: < 0.001, < 0.001 and 0.014), while a significant, positive association was observed for RR (p-value < 0.001). Associations were quantified with nonlinear functions, learned from the data. No cross-parameter interaction was significant (all p-values were larger than 0.10), suggesting a progressive, independent effect on the outcome as the value of each parameter departed from normality. Our results collide with the hypothesized existence of patterns of breathing parameters with specific prognostic weight in the early stages of the disease.© 2023. The Author(s), under exclusive licence to Società Italiana di Medicina Interna (SIMI).

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