The Association Between Alveolar-Arterial Oxygen Tension Difference and the Severity of COVID-19 in Patients

Canbin Xie; Jiayi Deng; Fanglin Li; Chenfang Wu; Min Xu; Bo Yu; Guobao Wu; Yanjun Zhong; Da Tang; Jinxiu Li

doi:10.1007/s40121-022-00752-3

The Association Between Alveolar-Arterial Oxygen Tension Difference and the Severity of COVID-19 in Patients

Infect Dis Ther. 2023 Feb;12(2):577-587. doi: 10.1007/s40121-022-00752-3. Epub 2023 Jan 5.

Authors

Canbin Xie¹, Jiayi Deng¹, Fanglin Li¹, Chenfang Wu¹, Min Xu¹, Bo Yu¹, Guobao Wu¹, Yanjun Zhong¹, Da Tang², Jinxiu Li³

Affiliations

¹ Critical Care Medicine, The Second Xiangya Hospital, Central South University, Changsha, China.
² Critical Care Medicine, The Second Xiangya Hospital, Central South University, Changsha, China. darmuyu@qq.com.
³ Critical Care Medicine, The Second Xiangya Hospital, Central South University, Changsha, China. jinxiuli2021@csu.edu.cn.

Abstract

Introduction: Coronavirus disease 2019 (COVID-19) emerged as a global pandemic and resulted in a significantly high death toll. Therefore, there is an urgent need to find a potential biomarker related to the disease severity that can facilitate early-stage intervention.

Methods: In the present study, we collected 242 laboratory-confirmed COVID-19-infected patients. The patients were grouped according to the alveolar to arterial oxygen tension difference (P_A-aO₂) value of COVID-19 infection after admission.

Results: Among the 242 laboratory-confirmed COVID-19- infected patients, 155 (64.05%) had an abnormal P_A-aO₂ value on admission. Compared with the normal P_A-aO₂ group, the median age of the abnormal P_A-aO₂ group was significantly older (p = 0.032). Symptoms such as fever, cough, and shortness of breath were more obvious in the abnormal P_A-aO₂ group. The proportion of severe events in the abnormal P_A-aO₂ group was higher than the normal P_A-aO₂ group (10.34% vs. 23.23%, p = 0.013). The abnormal P_A-aO₂ group had a higher possibility of developing severe events compared with the normal P_A-aO₂ group (HR 2.622, 95% CI 1.197-5.744, p = 0.016). After adjusting for age and common comorbidities (hypertension and cardiovascular disease), the abnormal P_A-aO₂ group still exhibited significantly elevated risks of developing severe events than the normal P_A-aO₂ group (HR 2.986, 95% CI 1.220-7.309, p = 0.017). Additionally, the abnormal P_A-aO₂ group had more serious inflammation/coagulopathy/fibrinolysis parameters than the normal P_A-aO₂ group.

Conclusion: Abnormal P_A-aO₂ value was found to be common in COVID-19 patients, was strongly related to severe event development, and could be a potential biomarker for the prognosis of COVID-19 patients.

Keywords: Biomarker; COVID-19; PA-aO2; Prognosis; Severe event.