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The association between high-oxygen saturation and prognosis for intracerebral hemorrhage

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Abstract

Background

Concerns about the adverse effects of excessive oxygen have grown over the years. This study investigated the relationship between high oxygen saturation and short-term prognosis of patients with spontaneous intracerebral hemorrhage (sICH) after liberal use of oxygen.

Methods

This retrospective cohort study collected data from the Medical Information Mart for Intensive Care III (MIMIC-III) database (ICU cohort) and a tertiary stroke center (general ward cohort). The data on pulse oximetry-derived oxygen saturation (SpO2) during the first 24 h in ICU and general wards were respectively extracted.

Results

Overall, 1117 and 372 patients were included in the ICU and general ward cohort, respectively. Among the patients from the ICU cohort, a spoon-shaped association was observed between minimum SpO2 and the risk of in-hospital mortality (non-linear P<0.0001). In comparison with minimum SpO2 of 93–97%, the minimum SpO2>97% was associated with a significantly higher risk of in-hospital mortality after adjustment for confounders. Sensitivity analysis conducted using propensity score matching did not change this significance. The same spoon-shaped association between minimum SpO2 and the risk of in-hospital mortality was also detected for the general ward cohort. In comparison with the group with 95–97% SpO2, the group with SpO2>97% showed a stronger association with, but non-significant risk for, in-hospital mortality after adjustment for confounders. The time-weighted average SpO2>97% was associated significantly with in-hospital mortality in both cohorts.

Conclusion

Higher SpO2 (especially a minimum SpO2>97%) was unrewarding after liberal use of oxygen among patients with sICH and might even be potentially detrimental.

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Data Availability

The source datasets used in this study are available from the following URL: https://figshare.com/s/242dff4a2bbc2f7cc575 or https://doi.org/10.6084/m9.figshare.23614446

Abbreviations

SpO2 :

Pulse oximetry-derived oxygen saturation

ICH:

Intracerebral hemorrhage

MIMIC-III:

Medical Information Mart for Intensive Care III database

OR:

Odds ratio

CI:

Confidence interval

RCS:

Restricted cubic splines

PSM:

Propensity score matching

FiO2:

Fraction of inspires oxygen

ROS:

Reactive oxygen species

BBB:

Blood-brain barrier

ICU:

Intensive care unit

STROBE:

Strengthening the Reporting of Observational Studies in Epidemiology

SOFA:

Sequential Organ Failure Assessment

APS:

Acute Physiology Score

GCS:

Glasgow Coma Scale

IPPV:

Invasive positive pressure ventilation

NIPPV:

Non-invasive positive pressure ventilation

HFNC:

High-flow nasal cannula

SD:

Standard deviation

IQR:

Interquartile range

RMST:

Restricted mean survival time

LED:

Life expectancy difference

LOWESS:

Locally weighted scatterplot smoothing

PaO2:

Partial pressure of oxygen in arterial blood

HR:

Hazard ratio

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Funding

This study was funded by the Senior Medical Talents Program of Chongqing for Young and Middle-aged.

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Authors and Affiliations

  1. Department of Neurosurgery, The Second Affiliated Hospital, Chongqing Medical University, Chongqing, 76 Linjiang Road, Chongqing, 400010, China

    Yu-tong Zhao, Ye Yuan, Yu-guang Tang, Hai Zhou & Zong-yi Xie

  2. Department of Intensive Care Unit, The Second Affiliated Hospital, Chongqing Medical University, Chongqing, 400010, China

    Shu-wei Zhang

Authors
  1. Yu-tong Zhao
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Contributions

All authors contributed to the study conception and design. The conception and design of the study were proposed by Yutong Zhao and Zongyi Xie; data collection and analysis were performed by Yutong Zhao, Ye Yuan, Hai Zhou, Yuguang Tang, and Shuwei Zhang. The first draft of the manuscript was written by Yutong Zhao. The revised manuscript was written by Yutong Zhao and Ye Yuan. The reviewed draft of the manuscript was revised by Zongyi Xie and Ye Yuan. All authors commented on previous versions of the manuscript. All authors read and approved the final manuscript. Yutong Zhao and Ye Yuan contributed equally to this work and should be considered co-first authors.

Corresponding author

Correspondence to Zong-yi Xie.

Ethics declarations

Ethics approval and consent to participate

The study was approved by the ethical standards of the institutional review board of the Massachusetts Institute of Technology (no. 53032805), the local institutional review boards (The National Drug Clinical Trial Institution, clinical study approval number: 2023-6), and the requirement for consent was waived.

Competing interests

All authors declare that they have no conflict of interest.

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Zhao, Yt., Yuan, Y., Tang, Yg. et al. The association between high-oxygen saturation and prognosis for intracerebral hemorrhage. Neurosurg Rev 47, 45 (2024). https://doi.org/10.1007/s10143-024-02283-6

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