{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,6,16]],"date-time":"2026-06-16T21:52:48Z","timestamp":1781646768833,"version":"3.54.5"},"reference-count":23,"publisher":"Springer Science and Business Media LLC","issue":"1","license":[{"start":{"date-parts":[[2026,3,27]],"date-time":"2026-03-27T00:00:00Z","timestamp":1774569600000},"content-version":"tdm","delay-in-days":0,"URL":"https:\/\/creativecommons.org\/licenses\/by\/4.0"},{"start":{"date-parts":[[2026,3,30]],"date-time":"2026-03-30T00:00:00Z","timestamp":1774828800000},"content-version":"vor","delay-in-days":3,"URL":"https:\/\/creativecommons.org\/licenses\/by\/4.0"}],"funder":[{"DOI":"10.13039\/501100004047","name":"Karolinska Institute","doi-asserted-by":"crossref","id":[{"id":"10.13039\/501100004047","id-type":"DOI","asserted-by":"crossref"}]}],"content-domain":{"domain":["link.springer.com"],"crossmark-restriction":false},"short-container-title":["Sci Rep"],"abstract":"<jats:title>Abstract<\/jats:title>\n                  <jats:p>\n                    Emerging evidence suggests that bidirectional lung\u2013kidney crosstalk may influence outcomes, but this has not been systematically evaluated in unselected emergency department populations. We therefore examined the association between peripheral oxygen saturation (SpO\u2082), estimated glomerular filtration rate (eGFR), and 30\u2011day mortality, and tested whether the prognostic association of oxygenation with mortality differs across levels of kidney function (and vice versa), using an SpO\u2082\u00d7eGFR interaction term to model effect modification We analyzed 12,651 adults with complete data on SpO\u2082, creatinine-derived eGFR, lactate, C-reactive protein (CRP), RETTS triage, and prespecified covariates from the Sk\u00e5ne Emergency Medicine (Sk\u00e5ne 17\/18) cohort (2017\u20132018). We fitted multivariable logistic regression models including SpO\u2082 and eGFR (Model 1) and then added an SpO\u2082\u00d7eGFR interaction term (Model 2). Nested models were compared using a likelihood-ratio test, and discrimination was compared using AUROC (DeLong test) based on model-predicted probabilities. In a predefined subgroup with arterial blood gases (\n                    <jats:italic>n<\/jats:italic>\n                    \u2009=\u20093,068), we evaluated eGFR in relation to PaO\u2082\/FiO\u2082 (P\/F). In the full cohort, SpO\u2082 and eGFR were significantly correlated. Adding the SpO\u2082\u00d7eGFR interaction term improved model fit versus the main-effects model (LRT \u0394Deviance\u2009=\u200915.77,\n                    <jats:italic>p<\/jats:italic>\n                    \u2009=\u20097.17\u2009\u00d7\u200910\u207b\u2075), but discrimination was essentially unchanged (AUROC 0.744 vs. 0.745; \u0394AUROC 0.0009; 95% CI\u2009\u2212\u20090.00227 to 0.00046; DeLong\n                    <jats:italic>p<\/jats:italic>\n                    \u2009=\u20090.193). In the interaction model, higher SpO\u2082 and eGFR were associated with lower 30-day mortality (OR 0.81, 95% CI 0.77\u20130.85; OR 0.85, 95% CI 0.80\u20130.91), and the interaction term indicated stronger protection when both were higher (OR 0.90, 95% CI 0.86\u20130.95). Exploratory subgroup analyses suggested the interaction effect was most pronounced among patients presenting with chest pain. SpO\u2082 and eGFR showed evidence of interaction in relation to 30-day mortality. Although adding the interaction term improved model fit, it did not meaningfully improve discrimination compared to main model (without interaction). This suggests that, in unselected ED populations, measuring and interpreting SpO\u2082 and eGFR remains clinically useful, whereas explicitly modeling their interaction is unlikely to add substantial predictive benefit.\n                  <\/jats:p>","DOI":"10.1038\/s41598-026-45757-x","type":"journal-article","created":{"date-parts":[[2026,3,27]],"date-time":"2026-03-27T16:45:44Z","timestamp":1774629944000},"update-policy":"https:\/\/doi.org\/10.1007\/springer_crossmark_policy","source":"Crossref","is-referenced-by-count":0,"title":["Interaction between oxygen saturation and renal function on 30-day mortality in emergency department patients"],"prefix":"10.1038","volume":"16","author":[{"given":"Ahmad","family":"Zwawi","sequence":"first","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Per","family":"Sw\u00e4rd","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Felix","family":"Forsberg","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Olle","family":"Melander","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Ulf","family":"Ekelund","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Anders","family":"Bj\u00f6rkelund","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Per","family":"W\u00e4ndell","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Axel C.","family":"Carlsson","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Toralph","family":"Ruge","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"297","published-online":{"date-parts":[[2026,3,27]]},"reference":[{"issue":"10","key":"45757_CR1","doi-asserted-by":"publisher","first-page":"701","DOI":"10.5005\/jp-journals-10071-24562","volume":"27","author":"T Banerjee","year":"2023","unstructured":"Banerjee, T. & Bose, P. Kidney-lung Crosstalk in Determining the Prognosis of Acute Kidney Injury Phenotypes in Acute Respiratory Distress Syndrome Patients. Indian J. Crit. Care Med. 27 (10), 701 (2023).","journal-title":"Indian J. Crit. Care Medicine: Peer-reviewed Official Publication Indian Soc. Crit. Care Med."},{"key":"45757_CR2","doi-asserted-by":"publisher","first-page":"744110","DOI":"10.3389\/fped.2021.744110","volume":"9","author":"J Alge","year":"2021","unstructured":"Alge, J. et al. Two to tango: kidney-lung interaction in acute kidney injury and acute respiratory distress syndrome. Front. Pead. 9, 744110 (2021).","journal-title":"Front. Pead."},{"key":"45757_CR3","doi-asserted-by":"crossref","unstructured":"Husain-Syed, F., Walmrath, H-D. & Birk, H-W. Lung-kidney cross-talk. Critical Care Nephrology: Elsevier; pp. 741-7. e2. (2019).","DOI":"10.1016\/B978-0-323-44942-7.00121-7"},{"key":"45757_CR4","doi-asserted-by":"crossref","unstructured":"De Rosa, S., Lassola, S., Taccone, F. 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The construction and use of the SEM cohort for research, including the present analysis, were approved by the Swedish Ethical Review Authority (Dnr 2019\u201105783) and Region Sk\u00e5ne (KVB 302\u201119). During data collection, patients received publicly available written information about the SEM cohort and its use for research and were given the opportunity to opt out at any time by contacting a research nurse or the first author. On this basis, informed consent for inclusion in the cohort was considered to have been obtained.","order":3,"name":"Ethics","group":{"name":"EthicsHeading","label":"Ethical approval and consent to participate"}}],"article-number":"10518"}}