Association between transcutaneous oxygen saturation within 24 h of admission and mortality in critically ill patients with non-traumatic subarachnoid hemorrhage: a retrospective analysis of the MIMIC-IV database

BACKGROUND: In critically ill patients, transcutaneous oxygen saturation (SpO(2)) upon admission is typically associated with in-hospital mortality. Nevertheless, the available information for patients with non-traumatic subarachnoid hemorrhage (SAH) is limited. In our study, our objective was to assess the correlation between SpO(2) levels and mortality among patients diagnosed with severe SAH. METHODS: In this study, we extracted data from the Medical Information Marketplace in Intensive Care (MIMIC-IV) database, which comprises information on critically ill patients. By employing matching ICD-9 and ICD-10 codes, we identified 3,328 patients diagnosed with SAH. Every individual who was admitted to the intensive care unit (ICU) had their SpO(2) data and various covariates, including age, sex, diagnosis, and duration of stay, recorded upon admission. Subsequently, the patients were categorized into three distinct groups according to their SpO(2) levels: low (≤95%), moderate (95–98%), and high (≥98%). To investigate the association between percutaneous oxygen saturation and mortality in patients with severe SAH, logistic regression, and cubic spline models were utilized. The main outcomes of interest were 28- and 90-day mortality rates. Additionally, subgroup analyses were conducted to evaluate these correlations and assess the consistency of interactions. RESULTS: A cohort of 864 patients diagnosed with non-traumatic SAH was included in this study. The correlation between SpO(2) and mortality displayed a U-shaped curve when utilizing a finite cubic spline function (non-linearity < 0.001), with the nadir in the probability of in-hospital death at 96%. Mortality at 28 and 90 days showed an inverse correlation with SpO(2) < 96% (adjusted odds ratio [OR], 0.8; 95% confidence interval [CI], 0.67–0.95, and 0.76; 95% CI, 0.6–0.96). Conversely, there was a positive correlation between percutaneous oxygen saturation (SpO(2)) levels of ≥96% and mortality rates at both 28 and 90 days (adjusted OR, 1.17; 95% CI, 1.02–1.35 and 1.2; 95% CI, 1.05–1.39). CONCLUSION: In patients with severe subarachnoid hemorrhage, the association between SpO(2) and mortality at 28 and 90 days demonstrated a U-shaped pattern. When SpO(2) levels were between 95 and 98%, both short- and long-term mortality rates were at their lowest. Patients with significant subarachnoid hemorrhage had a lower chance of survival when their SpO(2) values were either high or low.