Silent Hypoxia in Coronavirus disease-2019: Is it more dangerous?-A retrospective cohort study

  1. Prashant Sirohiya
  2. Arunmozhimaran Elavarasi
  3. Hari Krishna Raju Sagiraju
  4. Madhusmita Baruah
  5. Nishkarsh Gupta
  6. Rohit Kumar Garg
  7. Saurav Sekhar Paul
  8. Brajesh Kumar Ratre
  9. Ram Singh
  10. Balbir Kumar
  11. Saurabh Vig
  12. Anuja Pandit
  13. Abhishek Kumar
  14. Rakesh Garg
  15. Ved Prakash Meena
  16. Saurabh Mittal
  17. Saurabh Pahuja
  18. Nupur Das
  19. Tanima Dwivedi
  20. Ritu Gupta
  21. Sunil Kumar
  22. Manisha Pandey
  23. Abhinav Mishra
  24. Karanvir Singh Matharoo
  25. Anant Mohan
  26. Randeep Guleria
  27. Sushma Bhatnagar
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Abstract

Background

Hypoxia in patients with COVID-19 is one of the strongest predictors of mortality. Silent hypoxia is characterized by the presence of hypoxia without dyspnea.. Silent hypoxia has been shown to affect the outcomes in previous studies.

Research Question

Are the outcomes in patients presenting with silent hypoxia different from those presenting with dyspneic hypoxia?

Study design and Methods

This was a retrospective study of a cohort of patients with SARS-CoV-2 infection who were hypoxic at presentation. Clinical, laboratory, and treatment parameters in patients with silent hypoxia and dyspneic hypoxia were compared. Multivariate logistic regression models were fitted to identify the factors predicting mortality.

Results

Among 2080 patients with COVID-19 admitted to our hospital, 811 patients were hypoxic with SpO2<94% at the time of presentation. 174 (21.45%) did not have dyspnea since the onset of COVID-19 symptoms. 5.2% of patients were completely asymptomatic for COVID-19 and were found to be hypoxic only on pulse oximetry. The case fatality rate in patients with silent hypoxia was 45.4% as compared to 40.03% in dyspneic hypoxic patients (P=0.202). The odds ratio of death was 1.1 (95% CI 0.41-2.97) in the patients with silent hypoxia after adjusting for baseline characteristics, laboratory parameters, treatment, and in-hospital complications, which did not reach statistical significance (P=0.851).

Interpretation

Silent hypoxia may be the only presenting feature of COVID-19. Since the case fatality rate is comparable between silent and dyspneic hypoxia, it should be recognized early and treated as aggressively. Since home isolation is recommended in patients with COVID-19, it is essential to use pulse oximetry at the home setting to identify these patients.

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