Oxygen desaturation and adverse outcomes in acute stroke : Secondary analysis of the HeadPoST study

Journal article


Ouyang, Menglu, Roffe, Christine, Billot, Laurent, Song, Lili, Wang, Xia, Munoz-Venturelli, Paula, Lavados, Pablo M., Robinson, Thompson, Middleton, Sandy, Olavarría, Verónica V., Watkins, Caroline L., Lee, Tsong-Hai, Brunser, Alejandro M., Pontes-Neto, Octavio M., Hackett, Maree L. and Anderson, Craig S.. (2021). Oxygen desaturation and adverse outcomes in acute stroke : Secondary analysis of the HeadPoST study. Clinical Neurology and Neurosurgery. 207, p. Article: 106796. https://doi.org/10.1016/j.clineuro.2021.106796
AuthorsOuyang, Menglu, Roffe, Christine, Billot, Laurent, Song, Lili, Wang, Xia, Munoz-Venturelli, Paula, Lavados, Pablo M., Robinson, Thompson, Middleton, Sandy, Olavarría, Verónica V., Watkins, Caroline L., Lee, Tsong-Hai, Brunser, Alejandro M., Pontes-Neto, Octavio M., Hackett, Maree L. and Anderson, Craig S.
Abstract

Objective
Uncertainty exists over the prognostic significance of low arterial oxygen saturation (SaO2) in acute stroke. We aimed to determine the strength of association of SaO2 and adverse outcomes among participants of the international Head Positioning in acute Stroke Trial (HeadPoST).

Methods
Post-hoc analyzes of HeadPoST, a pragmatic cluster-crossover randomized trial of lying flat versus sitting up head positioning in 11,093 patients (age ≥18 years) with acute stroke at 114 hospitals in 9 countries during 2015–2016. Associations of the lowest recorded SaO2 level, as a continuous measure and as a cut-point for desaturation (SaO2 <93%), in the first 24 h and clinical outcomes of death or dependency (modified Rankin scale [mRS] scores 3–6) and any serious adverse event (SAE) at 90 days, were assessed in generalized linear mixed models adjusted for baseline and in-hospital management confounders.

Results
There was an inverse J-shaped association between SaO2 and death or dependency, with a nadir for optimal outcome at 96–97%. Patients with SaO2 desaturation were older, and had greater neurological impairment, premorbid disability and cardiorespiratory disease. Desaturation was not clearly associated with death or dependency (adjusted odds ratio [aOR] 1.19, 95% confidence interval [CI] 0.95–1.48) but was with SAEs (aOR 1.34, 95% CI 1.07–1.68), without heterogeneity by head position, cardiac-respiratory comorbidity, or other pre-specified subgroups.

Conclusions
Any change in SaO2 outside of 96–97% is associated with poorer outcome after acute stroke.

Clinical trial registration
HeadPoST is registered at ClinicalTrials.gov (NCT02162017).

Keywordsoxygen saturation; disability; acute stroke; head position; clinical trial
Year2021
JournalClinical Neurology and Neurosurgery
Journal citation207, p. Article: 106796
PublisherElsevier BV
ISSN0303-8467
Digital Object Identifier (DOI)https://doi.org/10.1016/j.clineuro.2021.106796
PubMed ID34246993
Scopus EID2-s2.0-85109441745
Research or scholarlyResearch
Page range1-6
FunderNational Health and Medical Research Council
Publisher's version
License
All rights reserved
File Access Level
Controlled
Output statusPublished
Publication dates
Online06 Jul 2021
Publication process dates
Accepted03 Jul 2021
Deposited24 Nov 2021
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