1. Breath‐holding physiology, radiological severity and adverse outcomes in COVID‐19 patients: A prospective validation study
- Author
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Messineo, Ludovico, Fanfulla, Francesco, Pedroni, Leonardo, Pini, Floriana, Borghesi, Andrea, Golemi, Salvatore, Vailati, Guido, Kerlin, Kayla, Malhotra, Atul, Corda, Luciano, and Sands, Scott
- Subjects
Biomedical and Clinical Sciences ,Clinical Sciences ,Clinical Research ,Lung ,Prevention ,Patient Safety ,4.2 Evaluation of markers and technologies ,Detection ,screening and diagnosis ,Humans ,COVID-19 ,SARS-CoV-2 ,Tomography ,X-Ray Computed ,Respiratory Insufficiency ,Retrospective Studies ,breath-holding procedure ,coronavirus disease ,incident adverse outcome ,mean desaturation ,physiology ,radiological severity ,Medical and Health Sciences ,Respiratory System ,Biomedical and clinical sciences ,Health sciences - Abstract
Background and objectiveCOVID-19 remains a major cause of respiratory failure, and means to identify future deterioration is needed. We recently developed a prediction score based on breath-holding manoeuvres (desaturation and maximal duration) to predict incident adverse COVID-19 outcomes. Here we prospectively validated our breath-holding prediction score in COVID-19 patients, and assessed associations with radiological scores of pulmonary involvement.MethodsHospitalized COVID-19 patients (N = 110, three recruitment centres) performed breath-holds at admission to provide a prediction score (Messineo et al.) based on mean desaturation (20-s breath-holds) and maximal breath-hold duration, plus baseline saturation, body mass index and cardiovascular disease. Odds ratios for incident adverse outcomes (composite of bi-level ventilatory support, ICU admission and death) were described for patients with versus without elevated scores (>0). Regression examined associations with chest x-ray (Brixia score) and computed tomography (CT; 3D-software quantification). Additional comparisons were made with the previously-validated '4C-score'.ResultsElevated prediction score was associated with adverse COVID-19 outcomes (N = 12/110), OR[95%CI] = 4.54[1.17-17.83], p = 0.030 (positive predictive value = 9/48, negative predictive value = 59/62). Results were diminished with removal of mean desaturation from the prediction score (OR = 3.30[0.93-11.72]). The prediction score rose linearly with Brixia score (β[95%CI] = 0.13[0.02-0.23], p = 0.026, N = 103) and CT-based quantification (β = 1.02[0.39-1.65], p = 0.002, N = 45). Mean desaturation was also associated with both radiological assessment. Elevated 4C-scores (≥high-risk category) had a weaker association with adverse outcomes (OR = 2.44[0.62-9.56]).ConclusionAn elevated breath-holding prediction score is associated with almost five-fold increased adverse COVID-19 outcome risk, and with pulmonary deficits observed in chest imaging. Breath-holding may identify COVID-19 patients at risk of future respiratory failure.
- Published
- 2022