Observational studyBMC pulmonary medicine2025
Association between oxygen debt (DEOx) variability over time and clinical outcomes in critically ill COVID-19 patients: an observational study.
Observational study in BMC pulmonary medicine, 2025. The graph could read no effect estimate from its abstract, so it casts no vote on the map. Not yet cited in PubMed.
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Abstract
backgroundOxygen debt (DEOx) quantifies oxygen deficit during shock, reflecting the transition to anaerobic metabolism due to decreased oxygen delivery (DO₂). This study aimed to analyze the temporal variation of DEOx values and their association with invasive mechanical ventilation (IMV) requirement and survival in patients with severe COVID-19.
methodsWe conducted a retrospective cohort study including adult patients admitted to the ICU with confirmed SARS-CoV-2 infection at Clínica Universidad de La Sabana (Colombia) between July 2020 and December 2021. DEOx was calculated using two validated formulas: one based on lactate (DEOx1) and another incorporating lactate and base excess (DEOx2). Variability in DEOx was assessed at different time points (≤6h, 6-12h, 12-24h, >24h) and its association with IMV and survival outcomes was analyzed.
resultsA total of 597 patients were included, of whom 150 (25.1%) died. DEOx1 within 6 hours was -6.87 (SD: 23.72) in patients requiring IMV by day 7, compared to -1.2 (SD: 7.83) in patients without IMV (p=0.004). DEOx2 within 6 hours on day 7 was -7.92 (SD: 30.7) vs. -1.57 (SD: 14.65) (p=0.027), and between 6 and 12 hours, it was 1.24 (SD: 14.92) vs. -3.54 (SD: 9.34) (p<0.001). 24 hours (SD: 36.09) in deceased patients on day 7, compared to -2.09 (SD: 14.26) in survivors (p<0.001). Between 6 and 12 hours, DEOx1 was 0.51 (SD: 11.49) vs.-2.27 (SD: 12.32) (p=0.016). At more than 24 hours, it was 3.21 (SD: 9.22) vs. -3.8 (SD: 20.91) (p<0.001). Similar trends were observed on days 14 and 28. DEOx2 within 6 hours on day 7 was -19.02 (SD: 35.3) vs. -1.36 (SD: 14.31) (p<0.001), and between 6 and 12 hours, it was 7.57 (SD: 18.78) vs. -1.94 (SD: 11.73) (p<0.001). At more than 24 hours, it was 2.6 (SD: 10.75) vs. -4.54 (SD: 17.26) (p<0.001). This pattern persisted on days 14 and 28.
conclusionDEOx variability in critically ill COVID-19 patients was significantly associated with IMV need and mortality. Higher DEOx values at ≤6h and persistent metabolic derangement beyond 24h correlated with worse outcomes.
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