Alveolar–Arterial Gradient Is an Early Marker to Predict Severe Pneumonia in COVID-19 Patients
Background: One of the main challenges in the management of COVID-19 patients is to early assess and stratify them according to their risk of developing severe pneumonia. The alveolar–arterial oxygen gradient (D(A-a)O<sub>2</sub>) is defined as the difference between the alveolar and art...
| Main Authors: | , , , , , , , , , , , , |
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| Format: | Article |
| Language: | English |
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MDPI AG
2022-06-01
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| Series: | Infectious Disease Reports |
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| Online Access: | https://www.mdpi.com/2036-7449/14/3/50 |
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| author | Giuseppe Pipitone Marta Camici Guido Granata Adriana Sanfilippo Francesco Di Lorenzo Calogero Buscemi Antonio Ficalora Daria Spicola Claudia Imburgia Ilenia Alongi Francesco Onorato Caterina Sagnelli Chiara Iaria |
| author_facet | Giuseppe Pipitone Marta Camici Guido Granata Adriana Sanfilippo Francesco Di Lorenzo Calogero Buscemi Antonio Ficalora Daria Spicola Claudia Imburgia Ilenia Alongi Francesco Onorato Caterina Sagnelli Chiara Iaria |
| author_sort | Giuseppe Pipitone |
| collection | DOAJ |
| description | Background: One of the main challenges in the management of COVID-19 patients is to early assess and stratify them according to their risk of developing severe pneumonia. The alveolar–arterial oxygen gradient (D(A-a)O<sub>2</sub>) is defined as the difference between the alveolar and arteriolar concentration of oxygen, an accurate index of the ventilatory function. The aim of this study is to evaluate D(A-a)O<sub>2</sub> as a marker for predicting severe pneumonia in COVID-19 patients, in comparison to the PaO<sub>2</sub>/FiO<sub>2</sub>. Methods: This retrospective, multicentric cohort study included COVID-19 patients admitted to two Italian hospitals between April and July 2020. Clinical and laboratory data were retrospectively collected at the time of hospital admission and during hospitalization. The presence of severe COVID-19 pneumonia was evaluated, as defined by the Infectious Diseases Society of America (IDSA) criteria for community-acquired pneumonia (CAP). Patients were divided in severe and non-severe groups. Results: Overall, 53 COVID-19 patients were included in the study: male were 30/53 (57%), and 10/53 (19%) had severe pneumonia. Patients with severe pneumonia reported dyspnea more often than non-severe patients (90% vs. 39.5%; <i>p</i> = 0.031). A history of chronic obstructive pulmonary disease (COPD) was recalled by 5/10 (50%) patients with severe pneumonia, and only in 6/43 (1.4%) of non-severe cases (<i>p</i> = 0.023). A ROC curve, for D(A-a)O<sub>2</sub> >60 mmHg in detecting severe pneumonia, showed an area under the curve (AUC) of 0.877 (95% CI: 0.675–1), while the AUC of PaO<sub>2</sub>/FiO<sub>2</sub> < 263 mmHg resulted 0.802 (95% CI: 0.544–1). D(A-a)O<sub>2</sub> in comparison to PaO<sub>2</sub>/FiO<sub>2</sub> had a higher sensibility (77.8% vs. 66.7%), positive predictive value (75% vs. 71.4%), negative predictive value (94% vs. 91%), and similar specificity (94.4% vs. 95.5%). Conclusions: Our study suggests that the D(A-a)O<sub>2</sub> is more appropriate than PaO<sub>2</sub>/FiO<sub>2</sub> to identify COVID-19 patients at risk of developing severe pneumonia early. |
| first_indexed | 2024-03-09T23:38:01Z |
| format | Article |
| id | doaj.art-7b0e6620fec74bf09b3133d2848d3071 |
| institution | Directory Open Access Journal |
| issn | 2036-7449 |
| language | English |
| last_indexed | 2024-03-09T23:38:01Z |
| publishDate | 2022-06-01 |
| publisher | MDPI AG |
| record_format | Article |
| series | Infectious Disease Reports |
| spelling | doaj.art-7b0e6620fec74bf09b3133d2848d30712023-11-23T16:56:59ZengMDPI AGInfectious Disease Reports2036-74492022-06-0114347047810.3390/idr14030050Alveolar–Arterial Gradient Is an Early Marker to Predict Severe Pneumonia in COVID-19 PatientsGiuseppe Pipitone0Marta Camici1Guido Granata2Adriana Sanfilippo3Francesco Di Lorenzo4Calogero Buscemi5Antonio Ficalora6Daria Spicola7Claudia Imburgia8Ilenia Alongi9Francesco Onorato10Caterina Sagnelli11Chiara Iaria12Infectious Disease Unit, ARNAS Civico-Di Cristina, Piazza Leotta 5, 90100 Palermo, ItalyNational Institute of Infectious Diseases Lazzaro Spallanzani, Via Portuense 292, 00149 Rome, ItalyNational Institute of Infectious Diseases Lazzaro Spallanzani, Via Portuense 292, 00149 Rome, ItalyInfectious Disease Unit, ARNAS Civico-Di Cristina, Piazza Leotta 5, 90100 Palermo, ItalyInfectious Disease Unit, ARNAS Civico-Di Cristina, Piazza Leotta 5, 90100 Palermo, ItalyInfectious Disease Unit, ARNAS Civico-Di Cristina, Piazza Leotta 5, 90100 Palermo, ItalyInfectious Disease Unit, ARNAS Civico-Di Cristina, Piazza Leotta 5, 90100 Palermo, ItalyInfectious Disease Unit, ARNAS Civico-Di Cristina, Piazza Leotta 5, 90100 Palermo, ItalyInfectious Disease Unit, ARNAS Civico-Di Cristina, Piazza Leotta 5, 90100 Palermo, ItalyInfectious Disease Unit, ARNAS Civico-Di Cristina, Piazza Leotta 5, 90100 Palermo, ItalyInfectious Disease Unit, ARNAS Civico-Di Cristina, Piazza Leotta 5, 90100 Palermo, ItalyInfectious Disease Unit, University Hospital Luigi Vanvitelli, Vico Luigi De Crecchio, 80138 Naples, ItalyInfectious Disease Unit, ARNAS Civico-Di Cristina, Piazza Leotta 5, 90100 Palermo, ItalyBackground: One of the main challenges in the management of COVID-19 patients is to early assess and stratify them according to their risk of developing severe pneumonia. The alveolar–arterial oxygen gradient (D(A-a)O<sub>2</sub>) is defined as the difference between the alveolar and arteriolar concentration of oxygen, an accurate index of the ventilatory function. The aim of this study is to evaluate D(A-a)O<sub>2</sub> as a marker for predicting severe pneumonia in COVID-19 patients, in comparison to the PaO<sub>2</sub>/FiO<sub>2</sub>. Methods: This retrospective, multicentric cohort study included COVID-19 patients admitted to two Italian hospitals between April and July 2020. Clinical and laboratory data were retrospectively collected at the time of hospital admission and during hospitalization. The presence of severe COVID-19 pneumonia was evaluated, as defined by the Infectious Diseases Society of America (IDSA) criteria for community-acquired pneumonia (CAP). Patients were divided in severe and non-severe groups. Results: Overall, 53 COVID-19 patients were included in the study: male were 30/53 (57%), and 10/53 (19%) had severe pneumonia. Patients with severe pneumonia reported dyspnea more often than non-severe patients (90% vs. 39.5%; <i>p</i> = 0.031). A history of chronic obstructive pulmonary disease (COPD) was recalled by 5/10 (50%) patients with severe pneumonia, and only in 6/43 (1.4%) of non-severe cases (<i>p</i> = 0.023). A ROC curve, for D(A-a)O<sub>2</sub> >60 mmHg in detecting severe pneumonia, showed an area under the curve (AUC) of 0.877 (95% CI: 0.675–1), while the AUC of PaO<sub>2</sub>/FiO<sub>2</sub> < 263 mmHg resulted 0.802 (95% CI: 0.544–1). D(A-a)O<sub>2</sub> in comparison to PaO<sub>2</sub>/FiO<sub>2</sub> had a higher sensibility (77.8% vs. 66.7%), positive predictive value (75% vs. 71.4%), negative predictive value (94% vs. 91%), and similar specificity (94.4% vs. 95.5%). Conclusions: Our study suggests that the D(A-a)O<sub>2</sub> is more appropriate than PaO<sub>2</sub>/FiO<sub>2</sub> to identify COVID-19 patients at risk of developing severe pneumonia early.https://www.mdpi.com/2036-7449/14/3/50COVID-19severity markeralveolar–arteriolar oxygen gradient |
| spellingShingle | Giuseppe Pipitone Marta Camici Guido Granata Adriana Sanfilippo Francesco Di Lorenzo Calogero Buscemi Antonio Ficalora Daria Spicola Claudia Imburgia Ilenia Alongi Francesco Onorato Caterina Sagnelli Chiara Iaria Alveolar–Arterial Gradient Is an Early Marker to Predict Severe Pneumonia in COVID-19 Patients Infectious Disease Reports COVID-19 severity marker alveolar–arteriolar oxygen gradient |
| title | Alveolar–Arterial Gradient Is an Early Marker to Predict Severe Pneumonia in COVID-19 Patients |
| title_full | Alveolar–Arterial Gradient Is an Early Marker to Predict Severe Pneumonia in COVID-19 Patients |
| title_fullStr | Alveolar–Arterial Gradient Is an Early Marker to Predict Severe Pneumonia in COVID-19 Patients |
| title_full_unstemmed | Alveolar–Arterial Gradient Is an Early Marker to Predict Severe Pneumonia in COVID-19 Patients |
| title_short | Alveolar–Arterial Gradient Is an Early Marker to Predict Severe Pneumonia in COVID-19 Patients |
| title_sort | alveolar arterial gradient is an early marker to predict severe pneumonia in covid 19 patients |
| topic | COVID-19 severity marker alveolar–arteriolar oxygen gradient |
| url | https://www.mdpi.com/2036-7449/14/3/50 |
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