| Summary: | Hypoxemia is a hallmark of coronavirus disease 2019 (COVID-19) severity. We sought to determine predictors of hypoxemia and related adverse outcomes among patients hospitalized with COVID-19 in the two largest hospitals in Jerusalem, Israel, from 9 March through 16 July 2020. Patients were categorized as those who developed reduced (<94%) vs. preserved (≥94%) arterial oxygen saturation (SpO<sub>2</sub>) within the first 48 h after arrival to the emergency department. Overall, 492 hospitalized patients with COVID-19 were retrospectively analyzed. Patients with reduced SpO<sub>2</sub> were significantly older, had more comorbidities, higher body surface area (BSA) and body mass index (BMI), lower lymphocyte counts, impaired renal function, and elevated liver enzymes, c-reactive protein (CRP), and D-dimer levels as compared to those with preserved SpO<sub>2</sub>. In the multivariable regression analysis, older age (odds ratio (OR) 1.02 per year, <i>p</i> < 0.001), higher BSA (OR 1.16 per 0.10 m<sup>2</sup>, <i>p</i> = 0.003) or BMI (OR 1.05 per 1 kg/m<sup>2</sup>, <i>p</i> = 0.011), lower lymphocyte counts (OR 1.72 per 1 × 10<sup>3</sup>/μL decrease, <i>p</i> = 0.002), and elevated CRP (1.11 per 1 mg/dL increase, <i>p</i> < 0.001) were found to be independent predictors of low SpO<sub>2</sub>. Severe hypoxemia requiring ventilatory support, older age, and pre-existing comorbidities, including underlying renal dysfunction and heart failure, were found to be significantly associated with in-hospital mortality. These findings suggest that assessment of predictors of hypoxemia early at the time of hospitalization with COVID-19 may be helpful in risk stratification and management.
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