Breath‐holding physiology, radiological severity and adverse outcomes in <scp>COVID</scp> ‐19 patients: A prospective validation study

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 (&gt;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 &#39;4C-score&#39;.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.