Interaction Effect Between Hemoglobin and Hypoxemia on COVID-19 Mortality: an observational study from Bogotá, Colombia

Ángela María Ruíz Sternberg; Ángela María Pinzón Rondón; Nicolás Molano-Gonzalez; David Rene Rodriguez Lima; Andrés Felipe Patiño Aldana

doi:10.2147/IJGM.S371067

Interaction Effect Between Hemoglobin and Hypoxemia on COVID-19 Mortality: an observational study from Bogotá, Colombia

Título traducido de la contribución: Efecto de la interacción entre hemoglobina e hipoxemia en la mortalidad por COVID-19: un estudio observacional de Bogotá, Colombia

Ángela María Ruíz Sternberg, Ángela María Pinzón Rondón, Nicolás Molano-Gonzalez, David Rene Rodriguez Lima, Andrés Felipe Patiño Aldana

Producción científica: Contribución a una revista › Artículo de Investigación › revisión exhaustiva

4 Citas (Scopus)

Resumen

Propósito: Nuestro objetivo fue evaluar el efecto de la concentración de hemoglobina (Hb) y el índice de oxigenación en la enfermedad COVID-19. Riesgo de mortalidad de 19 pacientes.
Pacientes y métodos: revisamos retrospectivamente las características sociodemográficas y clínicas, los hallazgos de laboratorio y los resultados clínicos de los pacientes ingresados en un hospital de tercer nivel de atención en Bogotá, Colombia, de marzo a julio de 2020. Evaluamos asociaciones exploratorias entre el índice de oxigenación y la concentración de Hb al ingreso y resultados clínicos. Utilizamos un modelo aditivo generalizado (GAM) para evaluar las relaciones no lineales observadas y el algoritmo de árboles de clasificación y regresión (CART) para evaluar los efectos de la interacción.
Resultados: Se incluyeron 550 pacientes, de los cuales el 52% eran hombres. La mediana de edad fue 57 años y la comorbilidad más frecuente fue la hipertensión arterial (29%). El valor mediano de SpO 2 /FiO 2 fue de 424 y la mediana de concentración de Hb fue de 15 g/dL. La mortalidad fue del 15,1% (83 pacientes). La edad, el sexo y la SpO 2 /FiO 2 se asociaron de forma independiente con la mortalidad. Describimos una relación no lineal entre la concentración de Hb y la proporción de neutrófilos a linfocitos con la mortalidad y un efecto de interacción entre SpO 2 /FiO 2 y la concentración de Hb. Los pacientes con un índice de oxigenación similar tenían diferentes probabilidades de mortalidad según su Hb al ingreso. El CART mostró que los pacientes con SpO 2 /FiO 2 < 324, menores de 81 años con un NLR > 9,9 y Hb > 15 g/dl tenían el mayor riesgo de mortalidad (91%). Además, los pacientes con SpO 2 /FiO 2 > 324 pero Hb < 12 g/dl y antecedentes de hipertensión tuvieron una mayor probabilidad de mortalidad (59%). Por el contrario, los pacientes con SpO 2 /FiO 2 > 324 y Hb > 12 g/dl tuvieron el riesgo de mortalidad más bajo (9%).
Conclusión: Encontramos que una disminución de SpO 2 /FiO 2 aumentó el riesgo de mortalidad. Los valores extremos de Hb, ya sean bajos o altos, mostraron un aumento en la probabilidad de mortalidad. Sin embargo, la concentración de Hb modificó la SpOefecto 2 /FiO 2 sobre la mortalidad; la probabilidad de muerte en pacientes con SpO 2 /FiO 2 baja aumentó a medida que aumentaba la Hb.

Título traducido de la contribución	Efecto de la interacción entre hemoglobina e hipoxemia en la mortalidad por COVID-19: un estudio observacional de Bogotá, Colombia
Idioma original	Inglés estadounidense
Páginas (desde-hasta)	6965-6976
Número de páginas	12
Publicación	International Journal of General Medicine
Volumen	15
DOI	https://doi.org/10.2147/IJGM.S371067
Estado	Publicada - sep. 2 2022

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@article{27639418468f454f995c33a7fb528f03,

title = "Interaction Effect Between Hemoglobin and Hypoxemia on COVID-19 Mortality: an observational study from Bogot{\'a}, Colombia",

abstract = "Purpose: We aimed to assess the effect of hemoglobin (Hb) concentration and oxygenation index on COVID-19 patients{\textquoteright} mortality risk. Patients and Methods: We retrospectively reviewed sociodemographic and clinical characteristics, laboratory findings, and clinical outcomes from patients admitted to a tertiary care hospital in Bogot{\'a}, Colombia, from March to July 2020. We assessed exploratory associations between oxygenation index and Hb concentration at admission and clinical outcomes. We used a generalized additive model (GAM) to evaluate the observed nonlinear relations and the classification and regression trees (CART) algorithm to assess the interaction effects. Results: We included 550 patients, of which 52% were male. The median age was 57 years old, and the most frequent comorbidity was hypertension (29%). The median value of SpO2 /FiO2 was 424, and the median Hb concentration was 15 g/dL. The mortality was 15.1% (83 patients). Age, sex, and SpO2 /FiO2, were independently associated with mortality. We described a nonlinear relationship between Hb concentration and neutrophil-to-lymphocyte ratio with mortality and an interaction effect between SpO2/FiO2 and Hb concentration. Patients with a similar oxygenation index had different mortality likelihoods based upon their Hb at admission. CART showed that patients with SpO2 /FiO2 < 324, who were less than 81 years with an NLR >9.9, and Hb > 15 g/dl had the highest mortality risk (91%). Additionally, patients with SpO2/FiO2 > 324 but Hb of < 12 g/dl and a history of hypertension had a higher mortality likelihood (59%). In contrast, patients with SpO2/FiO2 > 324 and Hb of > 12 g/dl had the lowest mortality risk (9%). Conclusion: We found that a decreased SpO2/FiO2 increased mortality risk. Extreme values of Hb, either low or high, showed an increase in the likelihood of mortality. However, Hb concentration modified the SpO2 /FiO2 effect on mortality; the probability of death in patients with low SpO2/FiO2 increased as Hb increased.",

author = "Sternberg, {{\'A}ngela Mar{\'i}a Ru{\'i}z} and Rond{\'o}n, {{\'A}ngela Mar{\'i}a Pinz{\'o}n} and Nicol{\'a}s Molano-Gonzalez and Lima, {David Rene Rodriguez} and {Pati{\~n}o Aldana}, {Andr{\'e}s Felipe}",

note = "Publisher Copyright: {\textcopyright} 2022 Pati{\~n}o-Aldana et al.",

year = "2022",

month = sep,

day = "2",

doi = "10.2147/IJGM.S371067",

language = "English (US)",

volume = "15",

pages = "6965--6976",

journal = "International Journal of General Medicine",

issn = "1178-7074",

publisher = "Dove Medical Press Ltd.",

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Interaction Effect Between Hemoglobin and Hypoxemia on COVID-19 Mortality: an observational study from Bogotá, Colombia. / Sternberg, Ángela María Ruíz ; Rondón, Ángela María Pinzón ; Molano-Gonzalez, Nicolás et al.
En: International Journal of General Medicine, Vol. 15, 02.09.2022, p. 6965-6976.

Producción científica: Contribución a una revista › Artículo de Investigación › revisión exhaustiva

TY - JOUR

T1 - Interaction Effect Between Hemoglobin and Hypoxemia on COVID-19 Mortality

T2 - an observational study from Bogotá, Colombia

AU - Sternberg, Ángela María Ruíz

AU - Rondón, Ángela María Pinzón

AU - Molano-Gonzalez, Nicolás

AU - Lima, David Rene Rodriguez

AU - Patiño Aldana, Andrés Felipe

PY - 2022/9/2

Y1 - 2022/9/2

N2 - Purpose: We aimed to assess the effect of hemoglobin (Hb) concentration and oxygenation index on COVID-19 patients’ mortality risk. Patients and Methods: We retrospectively reviewed sociodemographic and clinical characteristics, laboratory findings, and clinical outcomes from patients admitted to a tertiary care hospital in Bogotá, Colombia, from March to July 2020. We assessed exploratory associations between oxygenation index and Hb concentration at admission and clinical outcomes. We used a generalized additive model (GAM) to evaluate the observed nonlinear relations and the classification and regression trees (CART) algorithm to assess the interaction effects. Results: We included 550 patients, of which 52% were male. The median age was 57 years old, and the most frequent comorbidity was hypertension (29%). The median value of SpO2 /FiO2 was 424, and the median Hb concentration was 15 g/dL. The mortality was 15.1% (83 patients). Age, sex, and SpO2 /FiO2, were independently associated with mortality. We described a nonlinear relationship between Hb concentration and neutrophil-to-lymphocyte ratio with mortality and an interaction effect between SpO2/FiO2 and Hb concentration. Patients with a similar oxygenation index had different mortality likelihoods based upon their Hb at admission. CART showed that patients with SpO2 /FiO2 < 324, who were less than 81 years with an NLR >9.9, and Hb > 15 g/dl had the highest mortality risk (91%). Additionally, patients with SpO2/FiO2 > 324 but Hb of < 12 g/dl and a history of hypertension had a higher mortality likelihood (59%). In contrast, patients with SpO2/FiO2 > 324 and Hb of > 12 g/dl had the lowest mortality risk (9%). Conclusion: We found that a decreased SpO2/FiO2 increased mortality risk. Extreme values of Hb, either low or high, showed an increase in the likelihood of mortality. However, Hb concentration modified the SpO2 /FiO2 effect on mortality; the probability of death in patients with low SpO2/FiO2 increased as Hb increased.

AB - Purpose: We aimed to assess the effect of hemoglobin (Hb) concentration and oxygenation index on COVID-19 patients’ mortality risk. Patients and Methods: We retrospectively reviewed sociodemographic and clinical characteristics, laboratory findings, and clinical outcomes from patients admitted to a tertiary care hospital in Bogotá, Colombia, from March to July 2020. We assessed exploratory associations between oxygenation index and Hb concentration at admission and clinical outcomes. We used a generalized additive model (GAM) to evaluate the observed nonlinear relations and the classification and regression trees (CART) algorithm to assess the interaction effects. Results: We included 550 patients, of which 52% were male. The median age was 57 years old, and the most frequent comorbidity was hypertension (29%). The median value of SpO2 /FiO2 was 424, and the median Hb concentration was 15 g/dL. The mortality was 15.1% (83 patients). Age, sex, and SpO2 /FiO2, were independently associated with mortality. We described a nonlinear relationship between Hb concentration and neutrophil-to-lymphocyte ratio with mortality and an interaction effect between SpO2/FiO2 and Hb concentration. Patients with a similar oxygenation index had different mortality likelihoods based upon their Hb at admission. CART showed that patients with SpO2 /FiO2 < 324, who were less than 81 years with an NLR >9.9, and Hb > 15 g/dl had the highest mortality risk (91%). Additionally, patients with SpO2/FiO2 > 324 but Hb of < 12 g/dl and a history of hypertension had a higher mortality likelihood (59%). In contrast, patients with SpO2/FiO2 > 324 and Hb of > 12 g/dl had the lowest mortality risk (9%). Conclusion: We found that a decreased SpO2/FiO2 increased mortality risk. Extreme values of Hb, either low or high, showed an increase in the likelihood of mortality. However, Hb concentration modified the SpO2 /FiO2 effect on mortality; the probability of death in patients with low SpO2/FiO2 increased as Hb increased.

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Interaction Effect Between Hemoglobin and Hypoxemia on COVID-19 Mortality: an observational study from Bogotá, Colombia

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