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Mortality risk of hypoxaemic acute respiratory failure among Indonesians: A systematic review and meta-analysis

Menaldi Rasmin

Menaldi Rasmin

Department of Pulmonology & Respiratory Medicine, Faculty of Medicine Universitas Indonesia – National Respiratory Center Persahabatan HospitalJakarta, Indonesia
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Rasmin, Menaldi
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Dicky Soehadirman

Dicky Soehadirman

Department of Pulmonology & Respiratory Medicine, Faculty of Medicine Universitas Indonesia – National Respiratory Center Persahabatan HospitalJakarta, Indonesia
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Soehadirman, Dicky
, 
Ahmad Fadhil Ilham

Ahmad Fadhil Ilham

Medical and Scientific Writing Department, Respiratory Programmatic Implementation and Research Institute (RPRI)Jakarta, Indonesia
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Ilham, Ahmad Fadhil
, 
Gabrielle Adani

Gabrielle Adani

Medical and Scientific Writing Department, Respiratory Programmatic Implementation and Research Institute (RPRI)Jakarta, Indonesia
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Adani, Gabrielle
, 
Salsabila Rezkia Andini

Salsabila Rezkia Andini

Medical and Scientific Writing Department, Respiratory Programmatic Implementation and Research Institute (RPRI)Jakarta, Indonesia
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Andini, Salsabila Rezkia
, 
Elvan Wiyarta

Elvan Wiyarta

Medical and Scientific Writing Department, Respiratory Programmatic Implementation and Research Institute (RPRI)Jakarta, Indonesia
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Wiyarta, Elvan
 y 
Erlina Burhan

Erlina Burhan

  • Department of Pulmonology & Respiratory Medicine, Faculty of Medicine Universitas Indonesia – National Respiratory Center Persahabatan HospitalJakarta, Indonesia
  • Medical and Scientific Writing Department, Respiratory Programmatic Implementation and Research Institute (RPRI)Jakarta, Indonesia
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Burhan, Erlina
  
08 sept 2025
Mortality risk of hypoxaemic acute respiratory failure among Indonesians: A systematic review and meta-analysis's Cover Image
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Categoría del artículo: Review
Publicado en línea: 08 sept 2025
Páginas: 5 - 18
DOI: https://doi.org/10.2478/pneum-2025-0022
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© 2025 Menaldi Rasmin et al., published by Sciendo
This work is licensed under the Creative Commons Attribution-NonCommercial-NoDerivatives 4.0 International License.

Figure 1.

PRISMA 2020 flow diagram of study selection. PRISMA, preferred reporting items for systematic reviews and meta-analyses.
PRISMA 2020 flow diagram of study selection. PRISMA, preferred reporting items for systematic reviews and meta-analyses.

Figure 2.

Forest plot of mortality risk among hypoxaemic ARF. ARF, acute respiratory failure; CI, confidence interval.
Forest plot of mortality risk among hypoxaemic ARF. ARF, acute respiratory failure; CI, confidence interval.

Figure 3.

Subgroup analysis of mortality risk among hypoxaemic ARF in the pre-pandemic era. ARF, acute respiratory failure; CI, confidence interval.
Subgroup analysis of mortality risk among hypoxaemic ARF in the pre-pandemic era. ARF, acute respiratory failure; CI, confidence interval.

Figure 4.

Subgroup analysis of mortality risk among hypoxaemic ARF in the pandemic era. ARF, acute respiratory failure; CI, confidence interval.
Subgroup analysis of mortality risk among hypoxaemic ARF in the pandemic era. ARF, acute respiratory failure; CI, confidence interval.

Full search terms for journal databases_

Database Keyword
MEDLINE ((“hypoxaemia”[All Fields] OR “hypoxia”[MeSH Terms] OR “hypoxia”[All Fields] OR “hypoxemia”[All Fields] OR “hypoxemias”[All Fields] OR (“hypoxaemia”[All Fields] OR “hypoxia”[MeSH Terms] OR “hypoxia”[All Fields] OR “hypoxemia”[All Fields] OR “hypoxemias”[All Fields]) OR (“hypoxia”[MeSH Terms] OR “hypoxia”[All Fields] OR “hypoxias”[All Fields] OR “hypoxias”[All Fields]) OR (‘hypoxia”[MeSH Terms] OR ‘hypoxia”[All Fields] OR ‘anoxemia”[All Fields]) OR (‘hypoxia”[MeSH Terms] OR “hypoxia”[All Fields] OR “anoxia”[All Fields]) OR (“hypoxia”[MeSH Terms] OR “hypoxia”[All Fields] OR (“oxygen”[All Fields] AND “deficiencies”[All Fields]) OR “oxygen deficiencies”[All Fields]) OR (“hypoxia”[MeSH Terms] OR “hypoxia”[All Fields] OR (“oxygen”[All Fields] AND “deficiency”[All Fields]) OR “oxygen deficiency”[All Fields])) AND (Indonesia)) AND ((((((((Prevalence) OR (Prevalences)) OR (Period Prevalences)) OR (Period Prevalence)) OR (Point Prevalences)) OR (Point Prevalence)) OR (((((((((((((((Incidence) OR (Secondary Attack Rate)) OR (Secondary Attack Rates)) OR (Cumulative Incidence)) OR (Cumulative Incidences)) OR (Attack Rates)) OR (Attack Rate)) OR (Incidence Proportion)) OR (Incidence Proportions)) OR (Incidences)) OR (Person-time Rate)) OR (Incidence Rate)) OR (Person time Rate)) OR (Incidence Rates)) OR (Person-time Rates))) OR ((((((((((((((((((((((((Mortality risk) OR (Age-Specific Death Rate)) OR (Age-Specific Death Rates)) OR (Age Specific Death Rate)) OR (Excess Mortality)) OR (Excess Mortalities)) OR (Mortality Determinant)) OR (Mortality Determinants)) OR (Differential Mortality)) OR (Differential Mortalities)) OR (CFR Case Fatality Rate)) OR (Case Fatality Rate)) OR (Case Fatality Rates)) OR (Mortalities)) OR (Crude Death Rate)) OR (Crude Mortality Rates)) OR (Crude Death Rates)) OR (Crude Mortality Rate)) OR (Mortality Rate)) OR (Mortality Rates)) OR (Death Rate)) OR (Death Rates)) OR (Mortality Declines)) OR (Mortality Decline)))
Embase #1Hypoxaemia OR Hypoxemia OR Hypoxia OR Anoxemia OR Anoxia OR ‘Oxygen Deficiencies’ OR ‘Oxygen Deficiency’
#2Prevalence OR Prevalences OR ‘Period Prevalences’ OR ‘Period Prevalence’ OR ‘Prevalence, Period’ OR ‘Point Prevalences’ OR ‘Prevalence, Point’ OR ‘Point Prevalence’
#3Incidence OR ‘Secondary Attack Rate’ OR ‘Rate, Secondary Attack’ OR ‘Secondary Attack Rates’ OR ‘Attack Rate, Secondary’ OR ‘Proportion, Incidence’ OR ‘Incidence, Cumulative’ OR ‘Cumulative Incidence’ OR ‘Cumulative Incidences’ OR ‘Attack Rates’ OR ‘Attack Rate’ OR ‘Incidence Proportion’ OR ‘Incidence Proportions’ OR ‘Rate, Attack’ OR Incidences OR ‘Person-time Rate’ OR ‘Rate, Incidence’ OR ‘Incidence Rate’ OR ‘Rate, Person-time’ OR ‘Person time Rate’ OR ‘Incidence Rates’ OR ‘Person-time Rates’
#4‘Mortality risk’ OR ‘Age-Specific Death Rate’ OR ‘Death Rate, Age-Specific’ OR ‘Age-Specific Death Rates’ OR ‘Age Specific Death Rate’ OR ‘Rate, Age-Specific Death’ OR ‘Excess Mortality’ OR ‘Excess Mortalities’ OR ‘Mortality, Excess’ OR ‘Mortality Determinant’ OR ‘Determinants, Mortality’ OR ‘Mortality Determinants’ OR ‘Determinant, Mortality’ OR ‘Mortality, Differential’ OR ‘Differential Mortality’ OR ‘Differential Mortalities’ OR ‘Rates, Case Fatality’ OR ‘CFR’ OR ‘Case Fatality Rate’ OR ‘Rate, Case Fatality’ OR ‘Case Fatality Rate’ OR ‘Case Fatality Rates’ OR Mortalities OR ‘Crude Death Rate’ OR ‘Crude Mortality Rates’ OR ‘Rate, Crude Death’ OR ‘Crude Death Rates’ OR ‘Death Rate, Crude’ OR ‘Mortality Rate, Crude’ OR ‘Crude Mortality Rate’ OR ‘Rate, Crude Mortality’ OR ‘Mortality Rate’ OR ‘Rate, Death’ OR ‘Mortality Rates’ OR ‘Death Rate’ OR ‘Rate, Mortality’ OR ‘Death Rates’ OR ‘Mortality Declines’ OR ‘Decline, Mortality’ OR ‘Mortality Decline’
#5#2 OR #3 OR #4
#6Indonesia
#1 AND #5 AND #6
CENTRAL #1((((((Hypoxaemia) OR (Hypoxemia)) OR (Hypoxia)) OR (Anoxemia)) OR (Anoxia)) OR (Oxygen Deficiencies)) OR (Oxygen Deficiency)
#2Indonesia
#3(((((Prevalence) OR (Prevalences)) OR (Period Prevalences)) OR (Period Prevalence)) OR (Point Prevalences)) OR (Point Prevalence)
#4((((((((((((((Incidence) OR (Secondary Attack Rate)) OR (Secondary Attack Rates)) OR (Cumulative Incidence)) OR (Cumulative Incidences)) OR (Attack Rates)) OR (Attack Rate)) OR (Incidence Proportion)) OR (Incidence Proportions)) OR (Incidences)) OR(Person-time Rate)) OR (Incidence Rate)) OR (Person time Rate)) OR (Incidence Rates)) OR (Person-time Rates)
#5(((((((((((((((((((((((Mortality risk) OR (Age-Specific Death Rate)) OR (Age-Specific Death Rates)) OR (Age Specific Death Rate)) OR (Excess Mortality)) OR (Excess Mortalities)) OR (Mortality Determinant)) OR (Mortality Determinants)) OR (Differential Mortality)) OR (Differential Mortalities)) OR (CFR Case Fatality Rate)) OR (Case Fatality Rate)) OR (Case Fatality Rates)) OR (Mortalities)) OR (Crude Death Rate)) OR (Crude Mortality Rates)) OR (Crude Death Rates)) OR (Crude Mortality Rate)) OR (Mortality Rate)) OR (Mortality Rates)) OR (Death Rate)) OR (Death Rates)) OR (Mortality Declines)) OR (Mortality Decline)
#6(((((((Prevalence) OR (Prevalences)) OR (Period Prevalences)) OR (Period Prevalence)) OR (Point Prevalences)) OR (Point Prevalence)) OR (((((((((((((((Incidence) OR (Secondary Attack Rate)) OR (Secondary Attack Rates)) OR (Cumulative Incidence)) OR (Cumulative Incidences)) OR (Attack Rates)) OR (Attack Rate)) OR (Incidence Proportion)) OR (Incidence Proportions)) OR (Incidences)) OR (Person-time Rate)) OR (Incidence Rate)) OR (Person time Rate)) OR (Incidence Rates)) OR (Person-time Rates))) OR ((((((((((((((((((((((((Mortality risk) OR (Age-Specific Death Rate)) OR (Age-Specific Death Rates)) OR (Age Specific Death Rate)) OR (Excess Mortality)) OR (Excess Mortalities)) OR (Mortality Determinant)) OR (Mortality Determinants)) OR (Differential Mortality)) OR (Differential Mortalities)) OR (CFR Case Fatality Rate)) OR (Case Fatality Rate)) OR (Case Fatality Rates)) OR (Mortalities)) OR (Crude Death Rate)) OR (Crude Mortality Rates)) OR (Crude Death Rates)) OR (Crude Mortality Rate)) OR (Mortality Rate)) OR (Mortality Rates)) OR (Death Rate)) OR (Death Rates)) OR (Mortality Declines)) OR (Mortality Decline))
#1 AND #2 AND #6
Scopus (ALL((Hypoxaemia OR Hypoxemia OR Hypoxia OR Anoxemia OR Anoxia OR (Oxygen Deficiencies) OR (Oxygen Deficiency))) AND ALL((Prevalence OR Prevalences OR (Period Prevalences) OR (Period Prevalence) OR (Prevalence, Period) OR (Point Prevalences) OR (Prevalence, Point) OR (Point Prevalence) OR Incidence OR (Secondary Attack Rate) OR (Rate, Secondary Attack) OR (Secondary Attack Rates) OR (Attack Rate, Secondary) OR (Proportion, Incidence) OR (Incidence, Cumulative) OR (Cumulative Incidence) OR (Cumulative Incidences) OR (Attack Rates) OR (Attack Rate) OR (Incidence Proportion) OR (Incidence Proportions) OR (Rate, Attack) OR Incidences OR (Person-time Rate) OR (Rate, Incidence) OR (Incidence Rate) OR (Rate, Person-time) OR (Person time Rate) OR (Incidence Rates) OR (Person-time Rates) OR (Mortality risk) OR (Age-Specific Death Rate) OR (Death Rate, Age-Specific) OR (Age-Specific Death Rates) OR (Age Specific Death Rate) OR (Rate, Age-Specific Death) OR (Excess Mortality) OR (Excess Mortalities) OR (Mortality, Excess) OR (Mortality Determinant) OR (Determinants, Mortality) OR (Mortality Determinants) OR (Determinant, Mortality) OR (Mortality, Differential) OR (Differential Mortality) OR (Differential Mortalities) OR (Rates, Case Fatality) OR (CFR) OR (Case Fatality Rate) OR (Rate, Case Fatality) OR (Case Fatality Rate) OR (Case Fatality Rates) OR Mortalities OR (Crude Death Rate) OR (Crude Mortality Rates) OR (Rate, Crude Death) OR (Crude Death Rates) OR (Death Rate, Crude) OR (Mortality Rate, Crude) OR (Crude Mortality Rate) OR (Rate, Crude Mortality) OR (Mortality Rate) OR (Rate, Death) OR (Mortality Rates) OR (Death Rate) OR (Rate, Mortality) OR (Death Rates) OR (Mortality Declines) OR (Decline, Mortality) OR (Mortality Decline))) AND ALL(Indonesia))

Study characteristics table for included studies assessing mortality risk_

No. Author, year Location Data collection time Sample size (hypoxaemia patients) Population Mean (SD)/median (range) age (years) Definition of ARF Cause of ARF Findings
Frequency of the non-surv¡ved group Frequency of the survived group Percentage (%)
1 Amin et al. (2016) (15) Jakarta October 2015–August 2016 101 Patients aged >18 years, diagnosed with ARDS by Berlin criteria 52.7 (17.2) PaO2/FiO2≤300 Not specified Mild ARDS: 16 Moderate ARDS: 22 Severe ARDS: 15 Total: 53 Mild ARDS: 28 Moderate ARDS: 14 Severe ARDS: 6 Total: 48 Mild ARDS: 36.4 Moderate ARDS: 61.1 Severe ARDS: 71.4 Total: 52.48
2 Elhidsi et al. (2021) (16) Jakarta January 2017–December 2018 111 Patients aged ≥18 years, diagnosed with ARF caused by pulmonary tuberculosis N/A PaO2 < 60 mmHg, SpO2<91% and PaO2/FiO2<300 Tuberculosis 53 58 47.75
3 Made Reditya Noviyani et al. (2020) (17) Bali January 2018–December 2019 60 Children with ARDS admitted in the PICU during the data collection period ARDSp: 2 (1–180) monthsARDSexp: 6 (1–144) months PaO2/FiO2<300 Not specified ARDSp: 10 ARDSexp: 22 Total: 32 ARDSp: 20 ARDSexp: 8 Total: 28 ARDSp: 33.3 ARDSexp: 73.3 Total: 53.33
4 Nugraha et al. (2022) (18) East Java July–December 2020 78 Patients with the age of ≥18 years, confirmed COVID-19 by PCR test and the PaO2/FiO2 ratio of <300 mmHg were included. 47.75 (±13.39) years PaO2/FiO2 < 300 COVID-19 Mild ARDS: 1 Moderate ARDS: 9 Severe ARDS: 10 Total: 20 Mild ARDS: 9 Moderate ARDS: 36 Severe ARDS: 13 Total: 58 Mild ARDS: 5 Moderate ARDS: 45 Severe ARDS: 50
5 Nugrahani et al. (2022) (14) Central Java November 2020–September 2021 43 Patients diagnosed with COVID-19 during the data collection period N/A SpO2 < 90% COVID-19 31 12 72
6 Rasmin et al. (2018) (8) Jakarta January–December 2015 69 Patients aged >18 years, diagnosed with ARF 51 (15–92) years PaO2 < 60 mmHg, SaO2 < 91%, PaO2/FiO2 < 300 Not specified 28 41 40.58
7 Rasmin et al. (2021) (10) Jakarta East Java West Sumatera Aceh January–December 2017 228 Patients aged >17 years, diagnosed with ARF 56 (20–90) PaO2<60 mmHg SaO2< 91% PaO2/FiO2<300 Not specified 103 125 45.17
8 Valentania et al. (2021) (19) West Java May 2020–September 2020 67 Patients aged 1 month–18 years with pneumonia 23.5 (1–210) months SpO2< 90% Pneumonia 15 52 22.3

JBI risk of bias assessment of prevalence studies_

No. Author, year Outcome Was the sample frame appropriate to address the target population? Were study participants sampled in an appropriate way? Was the sample size adequate? Were the study subjects and the setting described in detail? Was the data analysis conducted with sufficient coverage of the identified sample? Were valid methods used for the identification of the condition? Was the condition measured in a standard, reliable way for all participants? Was there an appropriate statistical analysis? Was the response rate adequate, and if not, was the low response rate managed appropriately? Overall appraisal
1 Amin et al. (2016) (15) Mortality risk Yes Yes Yes Yes Yes Yes Yes Yes Yes Include
2 Elhidsi et al. (2021) (16) Mortality risk Yes Yes Yes Yes Yes Yes Yes Yes Yes Include
3 Made Reditya Noviyani et al., (2020) (17) Mortality risk Yes Yes Yes Yes Yes Yes Yes Yes Yes Include
4 Nugraha et al. (2022) (18) Mortality risk Yes Yes Yes Yes Yes Yes Yes Yes Yes Include
5 Nugrahani and Fauzi (2022) (14) Prevalence/incidence, mortality risk Yes Yes No Yes Yes Unclear Unclear Yes Yes Excluded from quantitative analysis due to inadequate sample size
6 Rasmin et al. (2018) (8) Mortality risk Yes Unclear Yes Yes Yes Yes Yes Yes Yes Include
7 Rasmin et al. (2021) (10) Mortality risk Yes Unclear Yes Yes Yes Yes Yes Yes Yes Include
8 Valentania et al. (2021) (19) Prevalence/incidence, mortality risk Yes Yes Yes Yes Yes Yes Yes Yes Yes Include

Hospital setting and details of mortality risk_

No. Author, year Hospital setting and measurement process Definition of mortality
1 Amin et al. (2016) (15) Hospital setting: Single point, unspecified inpatient settingTreatment prior to measurement: YesMeasurement process: arterial blood gas testAdditional information: - - Mortality type by cause: cause-specific mortality- Mortality type by interval: 28-day mortality
2 Elhidsi and Rasmin (2021) (16) Hospital setting: unspecified point at EDTreatment prior to measurement: YesMeasurement process: pulse oximetry and arterial blood gas testAdditional information: - - Mortality type by cause: cause-specific mortality, in-hospital mortality- Mortality type by interval: 30-day mortality
3 Made Reditya Noviyani et al. (2020) (17) Hospital setting: Single point at the PICUTreatment prior to measurement: YesMeasurement process: pulse oximetry or arterial blood gas testAdditional information: - - Mortality type by cause: cause-specific mortality- Mortality type by interval: N/A
4 Nugraha et al. (2022) (18) Hospital setting: Single point at ICUTreatment prior to measurement: YesMeasurement process: arterial blood gas testAdditional information: - - Mortality type by cause: cause-specific mortality- Mortality type by interval: 28-day mortality
5 Nugrahani and Fauzi (2022) (14) Hospital setting: unspecified point, Non-ICU and ICU settingTreatment prior to measurement: N/AMeasurement process: pulse oximetryAdditional information: - - Mortality type by cause: cause-specific mortality- Mortality type by interval: N/A
6 Rasmin et al. (2018) (8) Hospital setting: unspecified point, unspecified inpatient settingTreatment prior to measurement: YesMeasurement process: arterial blood gas testAdditional information: - - Mortality type by cause: cause-specific mortality, in-hospital mortality- Mortality type by interval: N/A
7 Rasmin et al. (2021) (10) Hospital setting: Single point, unspecified inpatient settingbTreatment prior to measurement: Yes (initial treatment at the ED)Measurement process: pulse oximetry and arterial blood gas testAdditional information: - - Cause of the mortality: cause-specific mortality, in-hospital mortality- Interval of mortality: unspecified interval
8 Valentania et al. (2021) (19) Hospital setting: Single point, unspecified inpatient settingTreatment prior to measurement: N/AMeasurement process: Pulse oximetryAdditional information: - - Cause of the mortality: cause-specific mortality, in-hospital mortality- Interval of mortality: unspecified interval
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Medicina, Medicina Clínica, Medicina Clínica, otros, Medicina Interna, Neumología
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