{
  "abstract": "Objectives To evaluate the accuracy of the arterial oxygen partial pressure/inspired oxygen fraction (PaO 2/FiO2) ratio in predicting mortality among acute respiratory distress syndrome (ARDS) patients in Vietnam.Design A retrospective observational study.Setting A central hospital in Vietnam.Participants Adult patients diagnosed with ARDS based on the Berlin definition and admitted to Bach Mai Hospital between August 2015 and August 2023. ARDS severity was converted from descriptive categories to the Berlin score, ranging from 1 (PaO 2/FiO2>300 mm Hg) to 4 (PaO2/FiO2≤100 mm Hg).Primary outcome All-cause hospital mortality.Results Of 345 patients, 67.5% were male, and the median age was 55.0 years (IQR: 39.0–66.0). Hospital mortality was 61.2% (211/345). On the first day of admission, the PaO 2/FiO2 ratio (areas under the receiver operating characteristic curves (AUROC): 0.585 (95% CI 0.522 to 0.649)) showed limited predictive ability for hospital mortality. Incorporating the PaO2/FiO2 ratio into the Berlin score did not substantially improve accuracy (AUROC: 0.578 (95% CI 0.516 to 0.641)). Both measures were less accurate than Sequential Organ Failure Assessment (SOFA) (AUROC: 0.650 (95% CI 0.590 to 0.711)), Acute Physiology and Chronic Health Evaluation II (APACHE II) (AUROC: 0.685 (95% CI 0.628 to 0.742)) and Confusion, Urea >7 mmol/L (20 mg/dL), Respiratory rate ≥30 breaths/min, Blood pressure (systolic <90 mm Hg or diastolic ≤60 mm Hg) and Age ≥65 years (CURB-65) (AUROC: 0.689 (95% CI 0.617 to 0.762)). Higher PaO2/FiO2 values (adjusted OR, AOR: 0.988 (95% CI 0.979 to 0.996)) were independently associated with lower mortality risk, while higher Berlin (AOR: 2.477 (95% CI 1.190 to 5.156)), SOFA (AOR: 1.278 (95% CI 1.102 to 1.482)), APACHE II (AOR: 1.236 (95% CI 1.108 to 1.379)) and CURB-65 (AOR: 7.142 (95% CI 2.581 to 19.763)) scores were associated with increased mortality risk.Conclusions In this study of ARDS patients in Vietnam, the PaO 2/FiO2 ratio demonstrated limited discriminatory ability for hospital mortality, and incorporating it into the Berlin score did not meaningfully improve performance. While less accurate than SOFA, APACHE II and CURB-65 scores, the PaO2/FiO2 ratio and Berlin score remained independently associated with mortality risk. These findings should be interpreted cautiously, given the retrospective design, single-centre setting and potential selection bias; further validation in larger, multicentre studies is warranted.",
  "authors": [
    {
      "affiliations": [
        "Neuro Intensive Care Department, National Institute of Neuroscience, Bach Mai Hospital, Hanoi, Viet Nam",
        "Department of Emergency and Critical Care Medicine, Hanoi Medical University, Hanoi, Viet Nam",
        "Department of Emergency and Critical Care Medicine, Faculty of Medicine, VNU University of Medicine and Pharmacy, Vietnam National University, Hanoi, Viet Nam"
      ],
      "name": "Chinh Quoc Luong"
    },
    {
      "affiliations": [
        "Department of Emergency and Critical Care Medicine, Hanoi Medical University, Hanoi, Viet Nam",
        "Department of Emergency and Critical Care Medicine, Faculty of Medicine, VNU University of Medicine and Pharmacy, Vietnam National University, Hanoi, Viet Nam",
        "Center for Critical Care Medicine, Bach Mai Hospital, Hanoi, Viet Nam"
      ],
      "name": "Co Xuan Dao"
    },
    {
      "affiliations": [
        "Department of Health Organization and Management, Faculty of Public Health, Thai Binh University of Medicine and Pharmacy, Hung Yen, Viet Nam"
      ],
      "name": "My Ha Nguyen"
    },
    {
      "affiliations": [
        "Department of Nutrition and Food Safety, Faculty of Public Health, Thai Binh University of Medicine and Pharmacy, Hung Yen, Viet Nam"
      ],
      "name": "Dung Thi Pham"
    },
    {
      "affiliations": [
        "Department of Emergency and Critical Care Medicine, Hanoi Medical University, Hanoi, Viet Nam",
        "Intensive Care Unit, University Medical Center Ho Chi Minh City, University of Medicine and Pharmacy at Ho Chi Minh City, Ho Chi Minh City, Viet Nam"
      ],
      "name": "Quynh Thi Pham"
    },
    {
      "affiliations": [
        "Department of Emergency and Critical Care Medicine, Hanoi Medical University, Hanoi, Viet Nam",
        "Emergency Department, Thai Nguyen National Hospital, Thai Nguyen, Viet Nam"
      ],
      "name": "Tai Thien Vu"
    },
    {
      "affiliations": [
        "Department of Emergency and Critical Care Medicine, Hanoi Medical University, Hanoi, Viet Nam",
        "Center for Critical Care Medicine, Bach Mai Hospital, Hanoi, Viet Nam",
        "Stroke Center, Bach Mai Hospital, Hanoi, Viet Nam"
      ],
      "name": "Hau Thi Truong"
    },
    {
      "affiliations": [
        "Neuro Intensive Care Department, National Institute of Neuroscience, Bach Mai Hospital, Hanoi, Viet Nam",
        "Department of Emergency and Critical Care Medicine, Hanoi Medical University, Hanoi, Viet Nam",
        "Emergency Department, Agriculture General Hospital, Hanoi, Viet Nam"
      ],
      "name": "Hai Hoang Nguyen"
    },
    {
      "affiliations": [
        "Neuro Intensive Care Department, National Institute of Neuroscience, Bach Mai Hospital, Hanoi, Viet Nam",
        "Department of Emergency and Critical Care Medicine, Hanoi Medical University, Hanoi, Viet Nam",
        "Center for Emergency Medicine, Bach Mai Hospital, Hanoi, Viet Nam"
      ],
      "name": "Thao Thi Phuong Nguyen"
    },
    {
      "affiliations": [
        "Department of Emergency and Critical Care Medicine, Hanoi Medical University, Hanoi, Viet Nam",
        "Department of Family Medicine, University of Medicine and Pharmacy, Thai Nguyen University, Thai Nguyen, Viet Nam"
      ],
      "name": "Hoai Thi Thu Luong"
    },
    {
      "affiliations": [
        "Center for Critical Care Medicine, Bach Mai Hospital, Hanoi, Viet Nam"
      ],
      "name": "Cuong Ba Nguyen"
    },
    {
      "affiliations": [
        "Department of Emergency and Critical Care Medicine, Hanoi Medical University, Hanoi, Viet Nam",
        "Center for Emergency Medicine, Bach Mai Hospital, Hanoi, Viet Nam"
      ],
      "name": "Dai Quoc Khuong"
    },
    {
      "affiliations": [
        "Department of Emergency and Critical Care Medicine, Faculty of Medicine, VNU University of Medicine and Pharmacy, Vietnam National University, Hanoi, Viet Nam",
        "Center for Critical Care Medicine, Bach Mai Hospital, Hanoi, Viet Nam"
      ],
      "name": "Hien Duy Dang"
    },
    {
      "affiliations": [
        "Department of Emergency and Critical Care Medicine, Faculty of Medicine, VNU University of Medicine and Pharmacy, Vietnam National University, Hanoi, Viet Nam",
        "Center for Emergency Medicine, Bach Mai Hospital, Hanoi, Viet Nam"
      ],
      "name": "Cong Hong Tran"
    },
    {
      "affiliations": [
        "Department of Emergency and Critical Care Medicine, Faculty of Medicine, VNU University of Medicine and Pharmacy, Vietnam National University, Hanoi, Viet Nam",
        "Center for Emergency Medicine, Bach Mai Hospital, Hanoi, Viet Nam"
      ],
      "name": "Tu Thanh Nguyen"
    },
    {
      "affiliations": [
        "Department of Emergency and Critical Care Medicine, Hanoi Medical University, Hanoi, Viet Nam",
        "Center for Emergency Medicine, Bach Mai Hospital, Hanoi, Viet Nam"
      ],
      "name": "Tuan Anh Nguyen"
    },
    {
      "affiliations": [
        "Department of Emergency and Critical Care Medicine, Hanoi Medical University, Hanoi, Viet Nam",
        "Department of Emergency and Critical Care Medicine, Faculty of Medicine, VNU University of Medicine and Pharmacy, Vietnam National University, Hanoi, Viet Nam",
        "Center for Critical Care Medicine, Bach Mai Hospital, Hanoi, Viet Nam"
      ],
      "name": "Thach The Pham"
    },
    {
      "affiliations": [
        "Department of Emergency and Critical Care Medicine, Hanoi Medical University, Hanoi, Viet Nam",
        "Center for Critical Care Medicine, Bach Mai Hospital, Hanoi, Viet Nam"
      ],
      "name": "Giang Thi Huong Bui"
    },
    {
      "affiliations": [
        "Department of Emergency and Critical Care Medicine, Hanoi Medical University, Hanoi, Viet Nam",
        "Department of Emergency and Critical Care Medicine, Faculty of Medicine, VNU University of Medicine and Pharmacy, Vietnam National University, Hanoi, Viet Nam",
        "Department of Intensive Care for Tropical Diseases, Bach Mai Institute for Tropical Medicine, Bach Mai Hospital, Hanoi, Viet Nam"
      ],
      "name": "Cuong Van Bui"
    },
    {
      "affiliations": [
        "Department of Emergency and Critical Care Medicine, Hanoi Medical University, Hanoi, Viet Nam",
        "Department of Emergency and Critical Care Medicine, Faculty of Medicine, VNU University of Medicine and Pharmacy, Vietnam National University, Hanoi, Viet Nam",
        "Center for Emergency Medicine, Bach Mai Hospital, Hanoi, Viet Nam"
      ],
      "name": "Quan Huu Nguyen"
    },
    {
      "affiliations": [
        "Department of Emergency and Critical Care Medicine, Hanoi Medical University, Hanoi, Viet Nam",
        "Department of Emergency and Critical Care Medicine, Faculty of Medicine, VNU University of Medicine and Pharmacy, Vietnam National University, Hanoi, Viet Nam",
        "Center for Emergency Medicine, Bach Mai Hospital, Hanoi, Viet Nam"
      ],
      "name": "Thong Huu Tran"
    },
    {
      "affiliations": [
        "Department of Emergency and Critical Care Medicine, Hanoi Medical University, Hanoi, Viet Nam",
        "Department of Emergency and Critical Care Medicine, Faculty of Medicine, VNU University of Medicine and Pharmacy, Vietnam National University, Hanoi, Viet Nam",
        "Center for Critical Care Medicine, Bach Mai Hospital, Hanoi, Viet Nam"
      ],
      "name": "Tan Cong Nguyen"
    },
    {
      "affiliations": [
        "Emergency Neurology Room, National Institute of Neuroscience, Bach Mai Hospital, Hanoi, Viet Nam",
        "Department of Neurology, Hanoi Medical University, Hanoi, Viet Nam",
        "Department of Neurology, Faculty of Medicine, VNU University of Medicine and Pharmacy, Vietnam National University, Hanoi, Viet Nam"
      ],
      "name": "Khoi Hong Vo"
    },
    {
      "affiliations": [
        "Department of Emergency and Critical Care Medicine, Hanoi Medical University, Hanoi, Viet Nam",
        "Center for Emergency Medicine, Bach Mai Hospital, Hanoi, Viet Nam"
      ],
      "name": "Lan Tuong Vu"
    },
    {
      "affiliations": [
        "Department of Health Organization and Management, Faculty of Public Health, Thai Binh University of Medicine and Pharmacy, Hung Yen, Viet Nam"
      ],
      "name": "Nga Thu Phan"
    },
    {
      "affiliations": [
        "Department of Health Sociology, Faculty of Public Health, Thai Binh University of Medicine and Pharmacy, Hung Yen, Viet Nam"
      ],
      "name": "Phuong Thi Ha Nguyen"
    },
    {
      "affiliations": [
        "Thai Binh Medical College Hospital, Thai Binh Medical College, Hung Yen, Viet Nam"
      ],
      "name": "Trong Dinh Nguyen"
    },
    {
      "affiliations": [
        "Department of Emergency and Critical Care Medicine, Thai Binh University of Medicine and Pharmacy, Hung Yen, Viet Nam"
      ],
      "name": "Cuong Duy Nguyen"
    },
    {
      "affiliations": [
        "Department of Emergency and Critical Care Medicine, Hanoi Medical University, Hanoi, Viet Nam",
        "Center for Emergency Medicine, Bach Mai Hospital, Hanoi, Viet Nam"
      ],
      "name": "Anh Dat Nguyen"
    },
    {
      "affiliations": [
        "Department of Emergency and Critical Care Medicine, Hanoi Medical University, Hanoi, Viet Nam",
        "Center for Emergency Medicine, Bach Mai Hospital, Hanoi, Viet Nam"
      ],
      "name": "Chi Van Nguyen"
    },
    {
      "affiliations": [
        "Department of Emergency and Critical Care Medicine, Hanoi Medical University, Hanoi, Viet Nam",
        "Center for Critical Care Medicine, Bach Mai Hospital, Hanoi, Viet Nam"
      ],
      "name": "Tuan Quoc Dang"
    },
    {
      "affiliations": [
        "Center for Critical Care Medicine, Bach Mai Hospital, Hanoi, Viet Nam",
        "Department of Pre-Hospital Emergency Medicine, Faculty of Medicine, VNU University of Medicine and Pharmacy, Vietnam National University, Hanoi, Viet Nam"
      ],
      "name": "Binh Gia Nguyen"
    },
    {
      "affiliations": [
        "Department of Emergency and Critical Care Medicine, Hanoi Medical University, Hanoi, Viet Nam",
        "Department of Emergency and Critical Care Medicine, Faculty of Medicine, VNU University of Medicine and Pharmacy, Vietnam National University, Hanoi, Viet Nam",
        "Center for Critical Care Medicine, Bach Mai Hospital, Hanoi, Viet Nam"
      ],
      "name": "Son Ngoc Do"
    }
  ],
  "title": "Prognostic value of the PaO2/FiO2 ratio for mortality in acute respiratory distress syndrome: a retrospective observational study in a lower-middle-income country",
  "uid": "01d94675-3ddd-5c4c-90e3-3fa941119826"
}