@article {Domaradzkirespcare.06797, author = {Lisa Domaradzki and Mehrdad Ghahramani and Ryan Rogers and Mohammed Ruzieh and Ryan Wilson and Andry Van de Louw}, title = {SpO2/FIO2 on Presentation as a Predictor for Early Hemodynamic Deterioration in Intermediate Risk Acute Pulmonary Embolism}, elocation-id = {respcare.06797}, year = {2019}, doi = {10.4187/respcare.06797}, publisher = {Respiratory Care}, abstract = {BACKGROUND: Patients with intermediate-risk acute pulmonary embolism are at risk of hemodynamic deterioration, and identification of risk factors for decompensation could guide the administration of thrombolytics. We aimed to assess whether SpO2/FIO2 on presentation is associated with early hemodynamic deterioration in this population.METHODS: A retrospective chart review of subjects admitted between 2006 and 2018 with intermediate-risk pulmonary embolism (hemodynamically stable with right ventricle to left ventricle ratio \> 0.9 or tricuspid annular plane systolic excursion \< 18 mm). Early hemodynamic deterioration was defined as requirements for vasopressors or rescue thrombolytics within 48 h. Results are presented as median (interquartile range).RESULTS: A total of 178 subjects were included. Early hemodynamic deterioration occurred in 13\% of the subjects and was associated with a median (interquartile range) lower SpO2/FIO2 on presentation in univariate analysis (243 [123{\textendash}275] versus 438 [335{\textendash}457], P \< .001) and in a multivariate analysis, including heart rate and right ventricle to left ventricle ratio as covariates (odds ratio 0.992, 95\% CI 0.987{\textendash}0.996; P \< .001). The initial SpO2/FIO2 predicted hemodynamic deterioration with an area under the receiver operating characteristic curve of 0.81 and a threshold of 260 was associated with a sensitivity of 74\% and specificity of 88\%. Sensitivity analyses restricted to subjects with hypoxemia on presentation and subjects with an elevated troponin level led to similar results.CONCLUSIONS: In intermediate-risk pulmonary embolism, SpO2/FIO2 on presentation can help predict the risk of early hemodynamic deterioration.}, issn = {0020-1324}, URL = {https://rc.rcjournal.com/content/early/2019/05/07/respcare.06797}, eprint = {https://rc.rcjournal.com/content/early/2019/05/07/respcare.06797.full.pdf}, journal = {Respiratory Care} }