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Characteristics and predictors for silent hypoxemia in a cohort of hospitalized COVID-19 patients.
Auton Neurosci. 2021 Jul 17; 235:102855.AN

Abstract

BACKGROUND

An intriguing feature recently unveiled in some COVID-19 patients is the "silent hypoxemia" phenomenon, which refers to the discrepancy of subjective well-being sensation while suffering hypoxia, manifested as the absence of dyspnea.

OBJECTIVE

To describe the clinical characteristics and predictors of silent hypoxemia in hospitalized COVID-19 patients.

METHODS

We conducted a prospective cohort study including consecutive hospitalized adult (≥ 18 years) patients with confirmed COVID-19 presenting to the emergency department with oxygen saturation (SpO2) ≤ 80% on room air from March 15 to June 30, 2020. We analyzed the characteristics, disease severity, and in-hospital outcomes of patients presenting with dyspnea and those without dyspnea (silent hypoxemia).

RESULTS

We studied 470 cases (64.4% men; median age 55 years, interquartile range 46-64). There were 447 (95.1%) patients with dyspnea and 23 (4.9%) with silent hypoxemia. The demographic and clinical characteristics, comorbidities, laboratory and imaging findings, disease severity, and outcomes were similar between groups. Higher breathing and heart rates correlated significantly with lower SpO2 in patients with dyspnea but not in those with silent hypoxemia. Independent predictors of silent hypoxemia were the presence of new-onset headache (OR 2.919, 95% CI 1.101-7.742; P = 0.031) and presenting to the emergency department within the first eight days after symptoms onset (OR 3.183, 95% CI 1.024-9.89; P = 0.045).

CONCLUSIONS

Patients with silent hypoxemia sought medical attention earlier and had new-onset headache more often. They were also likely to display lower hemodynamic compensatory responses to hypoxemia, which may underestimate the disease severity.

Authors+Show Affiliations

Department of Neurology and Psychiatry, Instituto Nacional de Ciencias Médicas y Nutrición Salvador Zubirán, Mexico City, Mexico.Department of Neurology and Psychiatry, Instituto Nacional de Ciencias Médicas y Nutrición Salvador Zubirán, Mexico City, Mexico.Department of Neurology and Psychiatry, Instituto Nacional de Ciencias Médicas y Nutrición Salvador Zubirán, Mexico City, Mexico.Department of Neurology and Psychiatry, Instituto Nacional de Ciencias Médicas y Nutrición Salvador Zubirán, Mexico City, Mexico.Department of Neurology and Psychiatry, Instituto Nacional de Ciencias Médicas y Nutrición Salvador Zubirán, Mexico City, Mexico.Department of Neurology and Psychiatry, Instituto Nacional de Ciencias Médicas y Nutrición Salvador Zubirán, Mexico City, Mexico.Department of Neurology and Psychiatry, Instituto Nacional de Ciencias Médicas y Nutrición Salvador Zubirán, Mexico City, Mexico.Department of Neurology and Psychiatry, Instituto Nacional de Ciencias Médicas y Nutrición Salvador Zubirán, Mexico City, Mexico.Department of Neurology and Psychiatry, Instituto Nacional de Ciencias Médicas y Nutrición Salvador Zubirán, Mexico City, Mexico.Department of Neurology and Psychiatry, Instituto Nacional de Ciencias Médicas y Nutrición Salvador Zubirán, Mexico City, Mexico.Department of Neurology and Psychiatry, Instituto Nacional de Ciencias Médicas y Nutrición Salvador Zubirán, Mexico City, Mexico. Electronic address: alejandra.gonzalezb@incmnsz.mx.

Pub Type(s)

Journal Article

Language

eng

PubMed ID

34293703

Citation

García-Grimshaw, Miguel, et al. "Characteristics and Predictors for Silent Hypoxemia in a Cohort of Hospitalized COVID-19 Patients." Autonomic Neuroscience : Basic & Clinical, vol. 235, 2021, p. 102855.
García-Grimshaw M, Flores-Silva FD, Chiquete E, et al. Characteristics and predictors for silent hypoxemia in a cohort of hospitalized COVID-19 patients. Auton Neurosci. 2021;235:102855.
García-Grimshaw, M., Flores-Silva, F. D., Chiquete, E., Cantú-Brito, C., Michel-Chávez, A., Vigueras-Hernández, A. P., Domínguez-Moreno, R., Chávez-Martínez, O. A., Sánchez-Torres, S., Marché-Fernández, O. A., & González-Duarte, A. (2021). Characteristics and predictors for silent hypoxemia in a cohort of hospitalized COVID-19 patients. Autonomic Neuroscience : Basic & Clinical, 235, 102855. https://doi.org/10.1016/j.autneu.2021.102855
García-Grimshaw M, et al. Characteristics and Predictors for Silent Hypoxemia in a Cohort of Hospitalized COVID-19 Patients. Auton Neurosci. 2021 Jul 17;235:102855. PubMed PMID: 34293703.
* Article titles in AMA citation format should be in sentence-case
TY - JOUR T1 - Characteristics and predictors for silent hypoxemia in a cohort of hospitalized COVID-19 patients. AU - García-Grimshaw,Miguel, AU - Flores-Silva,Fernando Daniel, AU - Chiquete,Erwin, AU - Cantú-Brito,Carlos, AU - Michel-Chávez,Anaclara, AU - Vigueras-Hernández,Alma Poema, AU - Domínguez-Moreno,Rogelio, AU - Chávez-Martínez,Oswaldo Alan, AU - Sánchez-Torres,Samantha, AU - Marché-Fernández,Osvaldo Alexis, AU - González-Duarte,Alejandra, Y1 - 2021/07/17/ PY - 2021/02/21/received PY - 2021/06/08/revised PY - 2021/07/12/accepted PY - 2021/7/23/pubmed PY - 2021/7/23/medline PY - 2021/7/22/entrez KW - COVID-19 KW - Happy hypoxemia KW - SARS-CoV-2 KW - Silent hypoxemia SP - 102855 EP - 102855 JF - Autonomic neuroscience : basic & clinical JO - Auton Neurosci VL - 235 N2 - BACKGROUND: An intriguing feature recently unveiled in some COVID-19 patients is the "silent hypoxemia" phenomenon, which refers to the discrepancy of subjective well-being sensation while suffering hypoxia, manifested as the absence of dyspnea. OBJECTIVE: To describe the clinical characteristics and predictors of silent hypoxemia in hospitalized COVID-19 patients. METHODS: We conducted a prospective cohort study including consecutive hospitalized adult (≥ 18 years) patients with confirmed COVID-19 presenting to the emergency department with oxygen saturation (SpO2) ≤ 80% on room air from March 15 to June 30, 2020. We analyzed the characteristics, disease severity, and in-hospital outcomes of patients presenting with dyspnea and those without dyspnea (silent hypoxemia). RESULTS: We studied 470 cases (64.4% men; median age 55 years, interquartile range 46-64). There were 447 (95.1%) patients with dyspnea and 23 (4.9%) with silent hypoxemia. The demographic and clinical characteristics, comorbidities, laboratory and imaging findings, disease severity, and outcomes were similar between groups. Higher breathing and heart rates correlated significantly with lower SpO2 in patients with dyspnea but not in those with silent hypoxemia. Independent predictors of silent hypoxemia were the presence of new-onset headache (OR 2.919, 95% CI 1.101-7.742; P = 0.031) and presenting to the emergency department within the first eight days after symptoms onset (OR 3.183, 95% CI 1.024-9.89; P = 0.045). CONCLUSIONS: Patients with silent hypoxemia sought medical attention earlier and had new-onset headache more often. They were also likely to display lower hemodynamic compensatory responses to hypoxemia, which may underestimate the disease severity. SN - 1872-7484 UR - https://www.unboundmedicine.com/medline/citation/34293703/Characteristics_and_predictors_for_silent_hypoxemia_in_a_cohort_of_hospitalized_COVID-19_patients. L2 - https://linkinghub.elsevier.com/retrieve/pii/S1566-0702(21)00085-0 DB - PRIME DP - Unbound Medicine ER -