{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,9,6]],"date-time":"2026-09-06T09:12:18Z","timestamp":1788685938594,"version":"build-2803163510"},"reference-count":37,"publisher":"Wiley","issue":"1","license":[{"start":{"date-parts":[[2025,10,29]],"date-time":"2025-10-29T00:00:00Z","timestamp":1761696000000},"content-version":"vor","delay-in-days":0,"URL":"http:\/\/creativecommons.org\/licenses\/by\/4.0\/"}],"content-domain":{"domain":["onlinelibrary.wiley.com"],"crossmark-restriction":true},"short-container-title":["Acta Anaesthesiol Scand"],"published-print":{"date-parts":[[2026,1]]},"abstract":"<jats:title>ABSTRACT<\/jats:title>\n                  <jats:sec>\n                    <jats:title>Background<\/jats:title>\n                    <jats:p>\n                      The ratio of arterial oxygen partial pressure to fraction of inspired oxygen (PaO\n                      <jats:sub>2<\/jats:sub>\n                      \/FiO\n                      <jats:sub>2<\/jats:sub>\n                      , hereafter P\/F ratio) is a key component of the Sequential Organ Failure Assessment (SOFA) score. It reflects the severity of hypoxaemic respiratory failure. The ongoing revision of the SOFA score requires data\u2010driven cutoffs for P\/F ratio as well as rational criteria for respiratory support. In this study, we aimed to determine the optimal P\/F ratio cutoffs for determining respiratory failure categories in the revised SOFA score and examined whether advanced respiratory support should be a prerequisite for the most severe categories.\n                    <\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Methods<\/jats:title>\n                    <jats:p>We used the database of the intensive care unit of Kuopio University Hospital, Finland, for cutoff derivation and the eICU database, a multicenter U.S. intensive care registry, for external validation. We identified cutoffs most discriminative for hospital mortality using the log\u2010rank statistic test with the Contal and O'Quigley method. In external validation, these cutoffs were compared with those in the current respiratory SOFA score.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Results<\/jats:title>\n                    <jats:p>\n                      Optimal cutoffs were identified as follows: P\/F ratio\u2009&gt;\u200940\u2009kPa (normal), 30\u201340\u2009kPa (mild impairment), 20\u201330\u2009kPa (moderate impairment), 10\u201320\u2009kPa (severe impairment), and\u2009\u2264\u200910\u2009kPa (critical impairment). These cutoffs resulted in clear separation of the severity categories (chi\u2010square for log\u2010rank statistic 356.9). They outperformed the current respiratory SOFA score cutoffs in the validation cohort (AUROC 0.615, 95% CI 0.607\u20130.622 vs. AUROC 0.610, 95% CI 0.603\u20130.618,\n                      <jats:italic>p<\/jats:italic>\n                      \u2009&lt;\u20090.001). Advanced respiratory support was associated with higher mortality, but its inclusion as a prerequisite improved discrimination only in the moderately impaired respiratory function category, not in the severely or critically impaired categories.\n                    <\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Conclusion<\/jats:title>\n                    <jats:p>P\/F ratio cutoffs using 10\u2009kPa (75\u2009mmHg) intervals were identified to be optimal for distinguishing stages of respiratory failure severity. The impact of respiratory support on P\/F ratio\u2013mortality associations suggests the need to calibrate any P\/F ratio\u2010based score by support level, but optimal calibration methods require further study.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Editorial Comment<\/jats:title>\n                    <jats:p>In this study, the cut\u2010off values for the partial pressure of arterial oxygen to the fraction of inspired oxygen (P\/F ratio) were investigated in a large Finnish intensive care database and validated externally with the US intensive care registry. The aim was to support a revision of the cut\u2010off values for the P\/F ratio in the Sequential Organ Failure Assessment (SOFA) score. The results showed that incremental changes in the P\/F ratio of 10\u2009kPa are better than 13\u2009kPa and emphasize the need for critical assessment of the current SOFA score.<\/jats:p>\n                  <\/jats:sec>","DOI":"10.1111\/aas.70137","type":"journal-article","created":{"date-parts":[[2025,10,29]],"date-time":"2025-10-29T18:50:50Z","timestamp":1761763850000},"update-policy":"https:\/\/doi.org\/10.1002\/crossmark_policy","source":"Crossref","is-referenced-by-count":3,"title":["Optimal Cutoffs for the Ratio of Arterial Oxygen Partial Pressure to Inspired Oxygen Fraction in Categorizing Respiratory Impairment Severity in Organ Failure Scores"],"prefix":"10.1111","volume":"70","author":[{"ORCID":"https:\/\/orcid.org\/0009-0006-8551-4394","authenticated-orcid":false,"given":"Anssi","family":"P\u00f6lkki","sequence":"first","affiliation":[{"name":"Department of Anaesthesiology and Intensive Care, Kuopio University Hospital and Institute of Clinical Medicine University of Eastern Finland  Kuopio Finland"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Matti","family":"Reinikainen","sequence":"additional","affiliation":[{"name":"Department of Anaesthesiology and Intensive Care, Kuopio University Hospital and Institute of Clinical Medicine University of Eastern Finland  Kuopio Finland"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Bram","family":"Rochwerg","sequence":"additional","affiliation":[{"name":"Department of Medicine and Department of Health Research Methods, Evidence, and Impact McMaster University  Hamilton Ontario Canada"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Christian","family":"Jung","sequence":"additional","affiliation":[{"name":"Department of Cardiology, Pulmonology and Vascular Medicine and Cardiovascular Research Institute Dusseldorf (CARID) Heinrich\u2010Heine\u2010University Duesseldorf  Duesseldorf 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