The risk of mortality and use of high-flow oxygen device based on respiratory distress clinical classification on emergency department admission: a retrospective study in Persahabatan Hospital, Jakarta

RDCC as risk for mortality and use of high-flow oxygen_

Respiratory distress statu	Mortality		Use of high-flow oxygen
	RR (95% CI)	P-value	RR (95% CI)	P-value
Severe (compared to mild-moderate)	3.00(1.61–5.60)	0.0006	5.40(2.22–13.12)	0.0002

Variables contributed to the use of high-flow oxygen in RDCC_

Variable	Use of high-flow oxygen (%)	Not using high-flow oxygen (%)	P-value
Age (years)			0.539
≤65	25 (24.3)	78 (75.7)
>65	7 (30.4)	16 (69.6)
Gender			0.936
Male	20 (25.6)	58 (74.4)
Female	12 (25.0)	36 (75.0)
Comorbid
Hypertension	7 (29.2)	17 (70.8)	0.637
Diabetes mellitus	10 (32.3)	21 (67.7)	0.312
Cardiac dysfunction	19 (54.3)	16 (45.7)	0.001
Renal insufficiency	14 (40.0)	21 (60.0)	0.020
Liver insufficiency	11 (33.3)	22 (66.7)	0.223
Neurology deficit	1 (50.0)	1 (50.0)	0.420
Respiratory distress status			<0.001
Mild-moderate	5 (7.9)	58 (92.1)
Severe	27 (42.9)	36 (57.1)

Baseline characteristics of study participants_

Variable	N = 126
Age (years), mean (SD)	51.14 (15)
Gender, n (%)
• Male	78 (61.9)
• Female	48 (38.1)
Primary diagnosis, n (%)
• Pneumonia	20 (15.9)
• Bronchiectasis	11 (8.7)
• Tuberculosis	38 (30.2)
• Lung malignancies	38 (30.2)
• COVID-19	10 (7.9)
• COPD/asthma	6 (4.8)
• Lung mycosis	2 (1.6)
• Lung abscess	1 (0.8)
Comorbid, n (%)
• Hypertension	24 (19.0)
• Diabetes mellitus	31 (24.6)
• Cardiac dysfunction	35 (27.8)
• Renal insufficiency	35 (27.8)
• Liver insufficiency	33 (26.2)
• Neurology insufficiency	2 (1.6)
Respiratory distress status, n (%)
• Mild	12 (9.5)
• Moderate	51 (40.5)
• Severe	63 (50)

Proposed RDCC_

Variable	0 points	1 point	2 points	3 points	Total
Consciousness	GCS 15	-	-	GCS <15
Respiratory rate (times/per)	<15	16–20	21–25	>26
Pulse oximetry (%)	99–100	93–98	88–92	<88

Clinical outcome related to RDCC_

Outcome	Mild, n (%)	Moderate, n (%)	Severe, n (%)	P-value
Mortality				<0.001
Alive	12 (100)	41 (80.4)	33 (52.4)
Death	0 (0)	10 (19.6)	30 (47.6)
Usage of high-flow oxygen				<0.001
Not used	12 (100)	46 (90.2)	36 (57.1)
Used	0 (0)	5 (9.8)	27 (42.9)

Proportion of respiratory distress, mortality and use of high-flow oxygen based on lung diseases_

Lung diseases	Total patients (n)	Severe respiratory distress (%)	Deaths (%)
Pneumonia	20	17 (85.0)	9 (45.0)
Bronchiectasis	11	7 (63.6)	2 (18.2)
Tuberculosis	38	10 (26.3)	8 (21.1)
Lung malignancies	38	15 (39.5)	15 (39.5)
COVID-19	10	8 (80.0)	6 (60.0)
COPD/asthma	6	5 (83.3)	0 (0.0)
Lung mycosis	2	1 (50)	0 (0.0)
Lung abscess	1	0 (0.0)	0 (0.0)

Respiratory distress classification_

Degree of respiratory distress	Consciousness	Respiratory rate (times/min)	Peripheral oxygen saturation (%)
Mild	Alert, good contact	15–20	93–98
Moderate	Alert, good contact	20–25	88–93
Severe	Apathetic, delirium	25–30	<88

Variables contributed to mortality in RDCC_

Variable	Non-survivor (death in 30 days) (%)	Survivor (%)	P-value
Age (years)			0.181
• ≤65	30 (29.1)	73 (30.9)
• >65	10 (43.5)	13 (56.5)
Gender			0.326
• Male	22 (28.2)	56 (71.8)
• Female	18 (37.5)	30 (62.5)
Comorbid
• Hypertension	7 (29.2)	17 (70.8)	0.763
• Diabetes mellitus	15 (48.4)	16 (51.6)	0.027
• Cardiac dysfunction	13 (37.1)	22 (62.9)	0.420
• Renal insufficiency	21 (60.0)	14 (40.0)	<0.001
• Liver insufficiency	18 (54.5)	15 (45.5)	0.002
• Neurology deficit	1 (50.0)	1 (50.0)	0.536
Respiratory distress status			<0.001
• Mild-moderate	10 (15.9)	53 (84.1)
• Severe	30 (47.6)	33 (52.4)