Hemoglobin Oxygen Saturation Discrepancy Using Various Methods in Patients with Sickle Cell Disease.
Notice bibliographique
Résumé
Abstract Objective: Sickle cell disease (SCD) is characterized by chronic hemolytic anemia and vaso-occlusive painful crises. Recurrent pulmonary microinfarction as well as increased predisposition to lung infection during vaso-occlusive crisis places these patients at high risk for hypoxemia. Furthermore, because hypoxemia is a trigger for sickling and vaso-occlusion, the detection of arterial hypoxemia and its correction are very important during painful episodes. We previously assessed reliability of pulse oximetry in pateints with SCD (Blood2001:98;491 abstr 2049). In present study we evaluated agreement among three available methods for measuring hemoglobin oxygen saturation in a relatively larger group of adult patients with SCD during vaso-occlusive crisis and compared them to a control group. Methods: Eighteen adult hypoxic patients with SCD hospitalized during a painful episode at a tertiary care institution served as the study group, whereas 12 non-SCD hypoxic African-American patients admitted with various cardio-pulmonary diagnoses served the control group. The hemoglobin oxygen saturation was determined simultaneously by pulse oximetry (SpO2), co-oximetry (SO2 [functional oxyhemoglobin saturation] & FO2Hb [oxyhemoglobin fraction]) and by calculation (SaO2) using a normal oxyhemoglobin dissociation curve in the 2 groups.Bland-Altman analysis was carried out to evaluate agreement of various methods in the two groups. Spearman Correlations were calculated for descriptive purposes. As a secondary analysis, McNemar’s Test was used to compare the proportion of ‘critically hypoxic’ patients between two measurement techniques. Results: The two groups were different with respect to age, systolic blood pressure, body temperature, hemoglobin level, serum bilirubin level, blood pH, methemoglobin and carboxyhemoglobin levels. Mean differences between various methods for measuring hemoglobin oxygen saturation in patients with SCD were significantly larger than the control group. Mean bias between SpO2 and SO2, and SpO2 and FO2Hb in patients with SCD were −3.1 ±4.4 (95% CI −11.7 to 5.5) and 2 ±4.1 (95% CI, −6 to 10) respectively compared to −1.4 ±1.4 (95% CI, −4 to 1.4) and 1.2 ±1.5 (95% CI, −1.8 to 4.2) in control group. A bias of −4.5 ±4 (95% CI, −12.3 to 3.8) between SpO2 and SaO2 was noted in patients with SCD compared to −0.08 ±2.1 (95% CI, −4.2 to 4.1) in control. Spearman correlations between various methods in control group were consistently higher (0.82 to 0.99) than patients with SCD (0.59 to 0.89). McNemar’s test for comparing the proportion of "Critically Hypoxic" disposition using a cut-point of 90% oxyhemoglobin saturation showed that there was poor agreement among methods in the sickle cell group whereas acceptable agreement was noted among methods in the control group. Conclusion: Patients with SCD during vaso-occlusive crisis have discrepancies in oxyhemoglobin saturation measurements by various methods. Abnormal pulse oximetry values in these patients should be interpreted cautiously and supplemented by PO2 and co-oximetry.
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Comment cette classification a été obtenuedéplier
Prédiction machine sur la base complète
Imitation des enseignantsNi prévalence calibrée, ni vérité terrain. Validation humaine à venir. Le volet Gemma est une étiquette directe du modèle pour chaque travail de la base, lue sur la notice réduite au titre. Le volet Codex est un classifieur appris des 10 348 étiquettes directes de Codex et calibré sur les taux pondérés de l'échantillon; les champs sans appui suffisant ne portent aucun appel Codex. Le mode candidate est l'union des deux volets; le consensus est leur intersection. Ces sorties portent le statut machine_predicted_unvalidated et ne sont pas des étiquettes humaines.
Scores du classifieur distillé par catégorie (deux têtes)
| Catégorie | Codex | Gemma |
|---|---|---|
| Métarecherche | 0,001 | 0,005 |
| Méta-épidémiologie (sens strict) | 0,000 | 0,000 |
| Méta-épidémiologie (sens large) | 0,000 | 0,000 |
| Bibliométrie | 0,001 | 0,001 |
| Études des sciences et des technologies | 0,000 | 0,000 |
| Communication savante | 0,000 | 0,000 |
| Science ouverte | 0,000 | 0,000 |
| Intégrité de la recherche | 0,000 | 0,000 |
| Charge utile insuffisante (le modèle a refusé de juger) | 0,001 | 0,000 |
Scores machine (provisoires)
Les deux têtes enseignantes du modèle étudiant, lues sur ce travail. Un score ordonne la base pour la relecture; il n'affirme jamais une catégorie, et le statut de validation accompagne chaque rangée tel quel.
Scores de référence d'un modèle non mature (critères de maturité non atteints, 7 itérations). Un score ordonne; il n'affirme jamais une catégorie.
score_only:v0-immature-baseline · tel quel depuis la passe de notation : score_only signifie que le nombre peut ordonner les travaux, et qu'aucune étiquette de catégorie n'en découleClassification
machine, non validéePrédiction automatique; un appel candidat d’une seule source (Gemma direct ou Codex distillé), pas un consensus.
Le détail, modèle par modèle et score par score, se trouve en fin de page sous « Comment cette classification a été obtenue ».