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Predicting deterioration in hospitalized adults with sickle cell disease and acute chest syndrome (ACS) is challenging. The ratio of arterial saturation (SaO2, measured by pulse oximetry) to the fraction of inspired oxygen (FiO2) has been used in critical care settings for risk stratification and mortality prediction in patients with acute respiratory distress syndrome. Researchers retrospectively evaluated 227 hospitalizations (128 patients; mean age, 29) for ACS (defined as new opacity on chest x-ray with either fever, hypoxia, chest pain, cough, wheezing, or shortness of breath) at a single center in Chicago.
Lower SaO2/FiO2 ratios at the time of ACS diagnosis or antibiotic initiation (but not at emergency department presentation) were as…