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Background <p>Acute respiratory failure is common in sepsis. When severe conditions like refractory hypoxemia or persistent CO2 retention occur, invasive mechanical ventilation (IMV) is required. The PaO2/FiO2 ratio is a key indicator for assessing acute respiratory failure severity and sepsis prognosis. This study investigates the early ICU trajectory of PaO2/FiO2 in septic patients requiring IMV for acute respiratory failure and its association with 28-day mortality.</p> Methods <p>This retrospective cohort study utilized the MIMIC-IV database to examine septic patients with acute respiratory failure receiving IMV. Group-based trajectory modeling (GBTM) classified PaO2/FiO2 trends over the first 96&#xa0;h. Cox and logistic regression assessed associations between trajectory patterns and 28-day or ICU mortality.</p> Results <p>Among 2270 patients, ICU mortality was 27.1% and 28-day mortality 31.2%. Five distinct PaO2/FiO2 trajectories were identified. Compared to the persistently low trajectory group, patients in trajectory 5 (initially low PaO2/FiO2 that improved and stabilized at a mildly reduced level) had significantly lower risks of 28-day mortality (HR 0.73, 95% CI 0.61–0.87) and ICU mortality (OR 0.64, 95% CI 0.50–0.81).</p> Conclusion <p>In patients with sepsis-related acute respiratory failure receiving invasive mechanical ventilation, early dynamic patterns of PaO2/FiO2 in the ICU are closely associated with short-term outcomes. Compared to those with persistently low oxygenation levels, patients whose PaO2/FiO2 was initially low but improved and stabilized at a mildly reduced level within 96&#xa0;h exhibited significantly lower risks of ICU and 28-day all-cause mortality. PaO2/FiO2 trajectories may serve as a valuable tool for early prognostic assessment in patients with sepsis.</p>

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Association between PaO2/FiO2 trajectories and survival outcomes in patients with sepsis-associated acute respiratory failure under invasive mechanical ventilation: a retrospective cohort analysis based on MIMIC-IV database

  • 期刊论文

  • 出版模式：

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  • 发表日期：

    2026年3月17日

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  • Ruiqi Qin,
  • Xingchen Gao,
  • Jing He

摘要

Background

Acute respiratory failure is common in sepsis. When severe conditions like refractory hypoxemia or persistent CO2 retention occur, invasive mechanical ventilation (IMV) is required. The PaO2/FiO2 ratio is a key indicator for assessing acute respiratory failure severity and sepsis prognosis. This study investigates the early ICU trajectory of PaO2/FiO2 in septic patients requiring IMV for acute respiratory failure and its association with 28-day mortality.

Methods

This retrospective cohort study utilized the MIMIC-IV database to examine septic patients with acute respiratory failure receiving IMV. Group-based trajectory modeling (GBTM) classified PaO2/FiO2 trends over the first 96 h. Cox and logistic regression assessed associations between trajectory patterns and 28-day or ICU mortality.

Results

Among 2270 patients, ICU mortality was 27.1% and 28-day mortality 31.2%. Five distinct PaO2/FiO2 trajectories were identified. Compared to the persistently low trajectory group, patients in trajectory 5 (initially low PaO2/FiO2 that improved and stabilized at a mildly reduced level) had significantly lower risks of 28-day mortality (HR 0.73, 95% CI 0.61–0.87) and ICU mortality (OR 0.64, 95% CI 0.50–0.81).

Conclusion

In patients with sepsis-related acute respiratory failure receiving invasive mechanical ventilation, early dynamic patterns of PaO2/FiO2 in the ICU are closely associated with short-term outcomes. Compared to those with persistently low oxygenation levels, patients whose PaO2/FiO2 was initially low but improved and stabilized at a mildly reduced level within 96 h exhibited significantly lower risks of ICU and 28-day all-cause mortality. PaO2/FiO2 trajectories may serve as a valuable tool for early prognostic assessment in patients with sepsis.