Evaluation of the SpO2/FiO2 ratio as a predictor of intensive care unit transfers in respiratory ward patients for whom the rapid response system has been activated

Won Gun Kwack, Dong Seon Lee, Hyunju Min, Yun Young Choi, Miae Yun, Youlim Kim, Sang Hoon Lee, Inae Song, Jong Sun Park, Young-Jae Cho, You Hwan Jo, Ho Il Yoon, Jae Ho Lee, Choon-Taek Lee, Yeon Joo Lee, Won Gun Kwack, Dong Seon Lee, Hyunju Min, Yun Young Choi, Miae Yun, Youlim Kim, Sang Hoon Lee, Inae Song, Jong Sun Park, Young-Jae Cho, You Hwan Jo, Ho Il Yoon, Jae Ho Lee, Choon-Taek Lee, Yeon Joo Lee

Abstract

Efforts to detect patient deterioration early have led to the development of early warning score (EWS) models. However, these models are disease-nonspecific and have shown variable accuracy in predicting unexpected critical events. Here, we propose a simpler and more accurate method for predicting risk in respiratory ward patients. This retrospective study analyzed adult patients who were admitted to the respiratory ward and detected using the rapid response system (RRS). Study outcomes included transfer to the intensive care unit (ICU) within 24 hours after RRS activation and in-hospital mortality. Prediction power of existing EWS models including Modified EWS (MEWS), National EWS (NEWS), and VitalPAC EWS (ViEWS) and SpO2/FiO2 (SF) ratio were compared to each other using the area under the receiver operating characteristic curve (AUROC). Overall, 456 patients were included; median age was 75 years (interquartile range: 65-80) and 344 (75.4%) were male. Seventy-three (16.0%) and 79 (17.3%) patients were transferred to the ICU and died. The SF ratio displayed better or comparable predictive accuracy for unexpected ICU transfer (AUROC: 0.744) compared to MEWS (0.744 vs. 0.653, P = 0.03), NEWS (0.744 vs. 0.667, P = 0.04), and ViEWS (0.744 vs. 0.675, P = 0.06). For in-hospital mortality, although there was no statistical difference, the AUROC of the SF ratio (0.660) was higher than that of each of the preexisting EWS models. In comparison with the preexisting EWS models, the SF ratio showed better or comparable predictive accuracy for unexpected ICU transfers in the respiratory wards.

Conflict of interest statement

The authors have declared that no competing interests exist.

Figures

Fig 1. Comparison of the area of…
Fig 1. Comparison of the area of under the receiver operating characteristics curve for intensive care unit transfers within 24 hours of rapid response system activation.
MEWS, Modified Early Warning Score; NEWS, National Early Warning Score; ViEWS, VitalPAC Early Warning Score; AUROC, area under the receiver operating characteristic curve; ICU, intensive care unit. *SF ratio: SpO2/FiO2 ratio.
Fig 2. Comparison of the area of…
Fig 2. Comparison of the area of under the receiver operating characteristics curve for in-hospital mortality.
MEWS, Modified Early Warning Score; NEWS, National Early Warning Score; ViEWS, VitalPAC Early Warning Score; AUROC, area under the receiver operating characteristic curve. *SF ratio: SpO2/FiO2 ratio.

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