An Examination of the Characterization of Oxygen Saturation in Hospitalized COVID-19 Patients: A Systematic Review

Keith Kamanga, Dharmendra Kumar Dubey

Abstract: Background: Many people with COVID-19 have low levels of oxygen in their blood, even when they feel well. Therefore, it is noted that low oxygen levels can be an early warning sign that medical care is needed urgently. A novel coronavirus-2 (SARS-CoV-2) was first identified in Wuhan, China, and quickly spread globally; a patient with COVID 19 experiences deterioration in oxygen saturation. Many treatments have been tried, of which sadly have proven ineffective. In this regard, it is necessary to review the published evidence of drug clinical trials to guide future recommendations in the management of severe oxygen distress. Therefore, measuring oxygen saturation has been proposed as one way of assessing illness severity in suspected or confirmed COVID-19 infection. In this systematic review, we aimed at determining the accuracy of oxygen saturation for predicting adverse outcomes in admitted COVID-19. Objective: This paper attempts to conduct a systematic review on various studies already done to understand the characterization of Oxygen Saturation in hospitalized COVID-19 patients. COVID-19 treatment and other interventions can be implemented in the management of COVID-19 patients to reduce the poor prognosis of the outcome. Also, to engage best possible prescriptions to improve the Oxygen Saturation. Methods: A systematic review of published clinical trials that followed retrospective observational studies was included. The search was made using PubMed, Ebscohost, Google Scholar, Springer, Clintrial.org databases. The researchers included articles published between the month of January 2020 and July 2021 and those written in English language; these articles were retrieved and included in the study. Researches that did not use human subjects were excluded. In addition, we undertook a sub-study of an observational cohort study across the COVID-19 pandemic in the UK; patients oxygen saturation recorded were selected for this systematic review. Results: We analyzed data from systematic review articles as regards patient?s oxygen saturation after excluding some articles whose measurement appeared not clear. The recorded results of oxygen saturation were 0.589 (95% CI 0.465: 0.713) respectively, and the positive and negative probability ratios of 3% or more desaturation were, 1.78 (1.25: 2.53) and 0.67 (0.46: 0.98) respectively. The secondary analysis further removed patients whose measurement results appeared unsuitable in a c-statistic of 0.699 (0.581 to 0.817) and showed a probability ratio of 1.98 (1.26:3.10) and 0.61 (0.35:1.07) respectively, and others indicated an additional prognostic value on multivariable analysis of p=0.019. Conclusions: Assessment of oxygen saturation provides uncertain prognostic information in the evaluation of selected patients attending the emergency department with suspected or confirmed COVID-19 infection. However, currently there are no approved treatment options worldwide for patients with COVID-19 despite the preliminary build-up with different remedies, including hydroxychloroquine and other repurposed drugs. Nevertheless, dexamethasone has shown promise in the symptomatic treatment and improving plasma in boosting immunity. In conclusion, it is noted that researchers are busy finding new treatments, and the discoveries will be reported accordingly to provide evidence-based guidance for prescribers and policymakers.

Keywords: COVID-19, Oxygen Saturation, High Nasal Oxygen Flow, Oxygen Dissociation Curve