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Oxygen desaturation and adverse outcomes in acute stroke : Secondary analysis of the HeadPoST study
Ouyang, Menglu Roffe, Christine Billot, Laurent Song, Lili Wang, Xia Munoz-Venturelli, Paula Lavados, Pablo M. Robinson, Thompson Middleton, Sandy Olavarría, Verónica V.
Ouyang, Menglu
Roffe, Christine
Billot, Laurent
Song, Lili
Wang, Xia
Munoz-Venturelli, Paula
Lavados, Pablo M.
Robinson, Thompson
Middleton, Sandy
Olavarría, Verónica V.
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).
Keywords
oxygen saturation, disability, acute stroke, head position, clinical trial
Date
2021
Type
Journal article
Journal
Clinical Neurology and Neurosurgery
Book
Volume
207
Issue
Page Range
1-6
Article Number
Article 106796
ACU Department
Nursing Research Institute
Faculty of Health Sciences
Faculty of Health Sciences
Collections
Relation URI
Source URL
Event URL
Open Access Status
Published as green open access
License
File Access
Controlled
Open
Open