Evidence map›Paper›PMID 41849519›Full record

ArticleCritical care science2026

Validation of PaO2:FiO2 for predicting hospital mortality in critically ill patients with acute hypoxaemic respiratory failure: a retrospective binational registry-based study.

Mahesh Ramanan, Benjamin Moran, Ryan Ruiyang Ling, Aidan Burrell, Ashwin Subramaniam, Kollengode Ramanathan, Mallikarjuna Ponnappa Reddy, David Pilcher, Kiran Shekar

Abstract readValidation Study
In one paragraph

Article in Critical care science, 2026. The graph could read no effect estimate from its abstract, so it casts no vote on the map. Cited by 1 paper.

0numbers the graph read from it
0cells of the map it votes in
1citing papers in PubMed
–field-weighted citation impact
1 · What the graph read from it

What it found

Each row is one number read from the abstract, on the scale the paper reported it, with its interval. Left of the dashed line favours the treatment, right favours the comparator. Under each row is the sentence it came from. New to these charts? A ten-minute tutorial.

The abstract states no effect estimate the extractor could read, or names no intervention and outcome on the map, so this paper lights no cell and moves no belief. It is still indexed, cited and linked below.

2 · The registry

The trial behind it

Trials whose registry record cites this paper, or whose number appears in the abstract. A trial that started after this paper was published is citing it as background, not reporting it.

Neither the registry nor the abstract names a trial number. If this is a trial report, that itself is worth knowing.

3 · Its place in the literature

Who cites it

1 citing paper in PubMed.

  1. Article
4 · The record

Corrections and comments

PubMed lists nothing against this paper. Absence here is not a guarantee, only a check that was made.

5 · Who and what money

Authors and funding

9 authors.

Mahesh RamananMetro North Hospital and Health Services - Brisbane, Queensland, Australia.ORCID http://orcid.org/0000-0003-4509-4015
Benjamin MoranDepartment of Anaesthesia and Department of Intensive Care, Gosford Hospital -Gosford, New South Wales, Australia.ORCID http://orcid.org/0000-0002-6515-6722
Ryan Ruiyang LingYong Loo Lin School of Medicine, National University of Singapore, National University Health System - Singapore, Singapore.ORCID http://orcid.org/0000-0002-8335-7640
Aidan BurrellDepartment of Intensive Care, Alfred Health - Prahran, Victoria, Australia.ORCID http://orcid.org/0000-0001-8430-9678
Ashwin SubramaniamDepartment of Intensive Care Medicine, Dandenong Hospital, Monash Health - Dandenong, Victoria, Australia.ORCID http://orcid.org/0000-0002-8292-7357
Kollengode RamanathanCardiothoracic Intensive Care Unit, Department of Cardiac, Thoracic, and Vascular Surgery, National University Heart Centre, National University Health System - Singapore, Singapore.ORCID http://orcid.org/0000-0003-1822-9455
Mallikarjuna Ponnappa ReddyDepartment of Anaesthesia and Pain Medicine, Nepean Hospital - Sydney, Australia.ORCID http://orcid.org/0000-0002-4736-2901
David PilcherCentre for Outcome and Resource Evaluation, Australian and New Zealand Intensive Care Society - Melbourne, Victoria, Australia.ORCID http://orcid.org/0000-0002-8939-7985
Kiran ShekarAdult Intensive Care Services, The Prince Charles Hospital - Chermside, Queensland, Australia.ORCID http://orcid.org/0000-0002-1239-7514

Funding

No grant is acknowledged in the PubMed record.

6 · The paper itself

Abstract

objectiveTo determine the optimal PaO2:FiO2 threshold in the first 24 hours of intensive care unit admission, and its associated discriminatory capacity, for prognostication of mortality among critically ill patients.

methodsThis bi-national registry included adult patients admitted to intensive care units in Australia and New Zealand from January-2018 to December-2022. The primary outcome was hospital mortality. Acute hypoxic respiratory failure was defined as PaO2:FiO2 of < 300 using the worst PaO2:FiO2 within the first 24 hours of intensive care unit admission. The unadjusted association between PaO2:FiO2 and hospital mortality was evaluated using restricted cubic splines with four knots to allow for continuous, non-linear associations. To determine the optimal threshold of the PaO2:FiO2 for predicting hospital mortality, Youden's method was used to identify the maximum sum of sensitivity and specificity. The area under the receiver operating characteristic curve and Youden's J-index were calculated to compare pre-specified subgroups.

resultsAmong the 662,612 included patients, acute hypoxic respiratory failure was not present in 324,761 (49%) patients, mild in 181,499 (27%) patients, moderate in 128,277 (19%) patients, and severe in 28,125 (4%) patients. The hospital mortality rates, respectively, were 4.9% (15,797/324,761), 7.9% (14,291/181,499), 14% (18,247/128,277), and 31% (8,717/28,125). The association between PaO2:FiO2 and hospital mortality was non-linear with an inflection point at PaO2:FiO2 = 200. The area under the ROC curve was 0.677 (95%CI 0.675 - 0.679) with an optimum PaO2:FiO2 threshold of 230. (Youden's J-index of 0.267, sensitivity 56.1% and specificity 70.6%). The area under the ROC curve was 0.627 for patients who required invasive ventilation during their intensive care unit stay, compared with 0.698 for those who did not.

conclusionThe optimal PaO2:FiO2 threshold for predicting hospital mortality was 230. PaO2:FiO2 has low discriminatory capacity in predicting hospital mortality among intensive care unit patients.

Indexed as

Blood Gas AnalysisCritical IllnessHospital MortalityHypoxiaOxygenRespiratory InsufficiencyAgedAustraliaFemaleHumansIntensive Care UnitsMaleMiddle AgedNew ZealandPredictive Value of TestsPrognosisOxygen

Identifiers

PMID41849519
PMCPMC13124106

What OpenQuestion holds

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LicenceCC BY
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Registered trials

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Read under generation 80e0d062 · epoch 390. Bibliography from PubMed, PubMed Central and OpenAlex; grants from NIH RePORTER; trial links from ClinicalTrials.gov; estimates, votes and beliefs from the OpenQuestion graph.