{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,7,18]],"date-time":"2026-07-18T09:28:06Z","timestamp":1784366886198,"version":"3.55.0"},"reference-count":36,"publisher":"MDPI AG","issue":"16","license":[{"start":{"date-parts":[[2021,8,14]],"date-time":"2021-08-14T00:00:00Z","timestamp":1628899200000},"content-version":"vor","delay-in-days":0,"URL":"https:\/\/creativecommons.org\/licenses\/by\/4.0\/"}],"content-domain":{"domain":[],"crossmark-restriction":false},"short-container-title":["JCM"],"abstract":"<jats:p>Hypoxemia is a hallmark of coronavirus disease 2019 (COVID-19) severity. We sought to determine predictors of hypoxemia and related adverse outcomes among patients hospitalized with COVID-19 in the two largest hospitals in Jerusalem, Israel, from 9 March through 16 July 2020. Patients were categorized as those who developed reduced (&lt;94%) vs. preserved (\u226594%) arterial oxygen saturation (SpO2) within the first 48 h after arrival to the emergency department. Overall, 492 hospitalized patients with COVID-19 were retrospectively analyzed. Patients with reduced SpO2 were significantly older, had more comorbidities, higher body surface area (BSA) and body mass index (BMI), lower lymphocyte counts, impaired renal function, and elevated liver enzymes, c-reactive protein (CRP), and D-dimer levels as compared to those with preserved SpO2. In the multivariable regression analysis, older age (odds ratio (OR) 1.02 per year, p &lt; 0.001), higher BSA (OR 1.16 per 0.10 m2, p = 0.003) or BMI (OR 1.05 per 1 kg\/m2, p = 0.011), lower lymphocyte counts (OR 1.72 per 1 \u00d7 103\/\u03bcL decrease, p = 0.002), and elevated CRP (1.11 per 1 mg\/dL increase, p &lt; 0.001) were found to be independent predictors of low SpO2. Severe hypoxemia requiring ventilatory support, older age, and pre-existing comorbidities, including underlying renal dysfunction and heart failure, were found to be significantly associated with in-hospital mortality. These findings suggest that assessment of predictors of hypoxemia early at the time of hospitalization with COVID-19 may be helpful in risk stratification and management.<\/jats:p>","DOI":"10.3390\/jcm10163581","type":"journal-article","created":{"date-parts":[[2021,8,15]],"date-time":"2021-08-15T21:43:55Z","timestamp":1629063835000},"page":"3581","update-policy":"https:\/\/doi.org\/10.3390\/mdpi_crossmark_policy","source":"Crossref","is-referenced-by-count":6,"title":["Predictors of Hypoxemia and Related Adverse Outcomes in Patients Hospitalized with COVID-19: A Double-Center Retrospective Study"],"prefix":"10.3390","volume":"10","author":[{"given":"Rabea","family":"Asleh","sequence":"first","affiliation":[{"name":"Heart Institute, Hadassah Medical Center, Faculty of Medicine, Hebrew University of Jerusalem, Jerusalem 91120, Israel"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0003-3381-605X","authenticated-orcid":false,"given":"Elad","family":"Asher","sequence":"additional","affiliation":[{"name":"The Jesselson Integrated Heart Center, Shaare Zedek Medical Center, Hebrew University of Jerusalem, Jerusalem 91031, Israel"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Oren","family":"Yagel","sequence":"additional","affiliation":[{"name":"Heart Institute, Hadassah Medical Center, Faculty of Medicine, Hebrew University of Jerusalem, Jerusalem 91120, Israel"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Tal","family":"Samuel","sequence":"additional","affiliation":[{"name":"The Jesselson Integrated Heart Center, Shaare Zedek Medical Center, Hebrew University of Jerusalem, Jerusalem 91031, Israel"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Gabby","family":"Elbaz-Greener","sequence":"additional","affiliation":[{"name":"Heart Institute, Hadassah Medical Center, Faculty of Medicine, Hebrew University of Jerusalem, Jerusalem 91120, Israel"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Arik","family":"Wolak","sequence":"additional","affiliation":[{"name":"The Jesselson Integrated Heart Center, Shaare Zedek Medical Center, Hebrew University of Jerusalem, Jerusalem 91031, Israel"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Ronen","family":"Durst","sequence":"additional","affiliation":[{"name":"Heart Institute, Hadassah Medical Center, Faculty of Medicine, Hebrew University of Jerusalem, Jerusalem 91120, Israel"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0001-5743-1387","authenticated-orcid":false,"given":"Eli","family":"Ben-Chetrit","sequence":"additional","affiliation":[{"name":"The Jesselson Integrated Heart Center, Shaare Zedek Medical Center, Hebrew University of Jerusalem, Jerusalem 91031, Israel"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Ran","family":"Nir-Paz","sequence":"additional","affiliation":[{"name":"Department of Clinical Microbiology and Infectious Disease, Hadassah University Medical Center, Faculty of Medicine, Hebrew University of Jerusalem, Jerusalem 91120, Israel"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Yigal","family":"Helviz","sequence":"additional","affiliation":[{"name":"The Jesselson Integrated Heart Center, Shaare Zedek Medical Center, Hebrew University of Jerusalem, Jerusalem 91031, Israel"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Limor","family":"Rubin","sequence":"additional","affiliation":[{"name":"Department of Allergy and Clinical Immunology, Hadassah University Medical Center, Faculty of Medicine, Hebrew University of Jerusalem, Jerusalem 91120, Israel"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-9371-6715","authenticated-orcid":false,"given":"Ariella","family":"Tvito","sequence":"additional","affiliation":[{"name":"The Jesselson Integrated Heart Center, Shaare Zedek Medical Center, Hebrew University of Jerusalem, Jerusalem 91031, Israel"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Michael","family":"Glikson","sequence":"additional","affiliation":[{"name":"The Jesselson Integrated Heart Center, Shaare Zedek Medical Center, Hebrew University of Jerusalem, Jerusalem 91031, Israel"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Offer","family":"Amir","sequence":"additional","affiliation":[{"name":"Heart Institute, Hadassah Medical Center, Faculty of Medicine, Hebrew University of Jerusalem, Jerusalem 91120, Israel"},{"name":"Department of Medicine, Azrieli Faculty of Medicine, Bar-Ilan University, Safed 13403, Israel"}],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"1968","published-online":{"date-parts":[[2021,8,14]]},"reference":[{"key":"ref_1","doi-asserted-by":"crossref","first-page":"497","DOI":"10.1016\/S0140-6736(20)30183-5","article-title":"Clinical features of patients infected with 2019 novel coronavirus in Wuhan, China","volume":"395","author":"Huang","year":"2020","journal-title":"Lancet"},{"key":"ref_2","doi-asserted-by":"crossref","first-page":"934","DOI":"10.1001\/jamainternmed.2020.0994","article-title":"Risk Factors Associated with Acute Respiratory Distress Syndrome and Death in Patients with Coronavirus Disease 2019 Pneumonia in Wuhan, China","volume":"180","author":"Wu","year":"2020","journal-title":"JAMA Intern. Med."},{"key":"ref_3","doi-asserted-by":"crossref","first-page":"430","DOI":"10.1038\/s41586-020-2521-4","article-title":"Factors associated with COVID-19-related death using OpenSAFELY","volume":"584","author":"Williamson","year":"2020","journal-title":"Nature"},{"key":"ref_4","doi-asserted-by":"crossref","first-page":"1054","DOI":"10.1016\/S0140-6736(20)30566-3","article-title":"Clinical course and risk factors for mortality of adult inpatients with COVID-19 in Wuhan, China: A retrospective cohort study","volume":"395","author":"Zhou","year":"2020","journal-title":"Lancet"},{"key":"ref_5","doi-asserted-by":"crossref","first-page":"168","DOI":"10.1016\/j.amepre.2020.05.002","article-title":"Clinical Characteristics, Associated Factors, and Predicting COVID-19 Mortality Risk: A Retrospective Study in Wuhan, China","volume":"59","author":"Yu","year":"2020","journal-title":"Am. J. Prev. Med."},{"key":"ref_6","doi-asserted-by":"crossref","first-page":"198","DOI":"10.1186\/s12931-020-01462-5","article-title":"The pathophysiology of \u2018happy\u2019 hypoxemia in COVID-19","volume":"21","author":"Dhont","year":"2020","journal-title":"Respir. Res."},{"key":"ref_7","unstructured":"World Health Organization (2020). Clinical Management of COVID-19 Interim Guidance, World Health Organization."},{"key":"ref_8","doi-asserted-by":"crossref","first-page":"1239","DOI":"10.1001\/jama.2020.2648","article-title":"Characteristics of and Important Lessons from the Coronavirus Disease 2019 (COVID-19) Outbreak in China","volume":"323","author":"Wu","year":"2020","journal-title":"JAMA"},{"key":"ref_9","unstructured":"Aylward, B., and Liang, W. (2020). (PRC) Report of the WHO-China Joint Mission on Coronavirus Disease 2019 (COVID-19), World Health Organization."},{"key":"ref_10","doi-asserted-by":"crossref","first-page":"1094","DOI":"10.1016\/j.mayocp.2020.04.021","article-title":"Hypoxia in COVID-19: Sign of Severity or Cause for Poor Outcomes","volume":"95","author":"Kashani","year":"2020","journal-title":"Mayo Clin. Proc."},{"key":"ref_11","doi-asserted-by":"crossref","first-page":"1099","DOI":"10.1007\/s00134-020-06033-2","article-title":"COVID-19 pneumonia: Different respiratory treatments for different phenotypes?","volume":"46","author":"Gattinoni","year":"2020","journal-title":"Intensive Care Med."},{"key":"ref_12","doi-asserted-by":"crossref","first-page":"413","DOI":"10.1016\/j.annemergmed.2020.07.035","article-title":"Excess Out-of-Hospital Mortality and Declining Oxygen Saturation: The Sentinel Role of Emergency Medical Services Data in the COVID-19 Crisis in Tijuana, Mexico","volume":"76","author":"Friedman","year":"2020","journal-title":"Ann. Emerg. Med."},{"key":"ref_13","doi-asserted-by":"crossref","first-page":"1098","DOI":"10.1056\/NEJM198710223171717","article-title":"Simplified calculation of body-surface area","volume":"317","author":"Mosteller","year":"1987","journal-title":"N. Engl. J. Med."},{"key":"ref_14","first-page":"2526","article-title":"Acute respiratory distress syndrome: The Berlin Definition","volume":"307","author":"Ranieri","year":"2012","journal-title":"JAMA"},{"key":"ref_15","doi-asserted-by":"crossref","first-page":"473","DOI":"10.1126\/science.abb8925","article-title":"Cytokine release syndrome in severe COVID-19","volume":"368","author":"Moore","year":"2020","journal-title":"Science"},{"key":"ref_16","doi-asserted-by":"crossref","first-page":"2339","DOI":"10.1016\/j.mayocp.2020.09.015","article-title":"Progressive Hypoxia: A pivotal pathophysiologic mechanism of COVID-19 pneumonia","volume":"95","author":"Somers","year":"2020","journal-title":"Mayo Clin. Proc."},{"key":"ref_17","doi-asserted-by":"crossref","first-page":"656","DOI":"10.1056\/NEJMra0910283","article-title":"Hypoxia and Inflammation","volume":"364","author":"Eltzschig","year":"2011","journal-title":"N. Engl. J. Med."},{"key":"ref_18","doi-asserted-by":"crossref","unstructured":"L\u00f3pez-Rodr\u00edguez, D.M., Kirillov, V., Krug, L.T., Mesri, E.A., and Andreansky, S. (2019). A role of hypoxia-inducible factor 1 alpha in Murine Gammaherpesvirus 68 (MHV68) lytic replication and reactivation from latency. PLoS Pathog., 15.","DOI":"10.1101\/791616"},{"key":"ref_19","doi-asserted-by":"crossref","first-page":"2935","DOI":"10.1128\/JVI.02534-12","article-title":"Low Oxygen Tension Enhances Hepatitis C Virus Replication","volume":"87","author":"Vassilaki","year":"2013","journal-title":"J. Virol."},{"key":"ref_20","doi-asserted-by":"crossref","first-page":"1639","DOI":"10.1183\/09031936.00013908","article-title":"Regulation of hypoxic pulmonary vasoconstriction: Basic mechanisms","volume":"32","author":"Sommer","year":"2008","journal-title":"Eur. Respir. J."},{"key":"ref_21","doi-asserted-by":"crossref","first-page":"e38","DOI":"10.1056\/NEJMc2007575","article-title":"Coagulopathy and Antiphospholipid Antibodies in Patients with Covid-19","volume":"382","author":"Zhang","year":"2020","journal-title":"N. Engl. J. Med."},{"key":"ref_22","doi-asserted-by":"crossref","first-page":"452","DOI":"10.1182\/blood-2018-04-841585","article-title":"Hypoxia downregulates protein S expression","volume":"132","author":"Pilli","year":"2018","journal-title":"Blood"},{"key":"ref_23","doi-asserted-by":"crossref","first-page":"849","DOI":"10.1507\/endocrj.EJ20-0784","article-title":"Obesity, glucose intolerance, advanced age, and lymphocytopenia are independent risk factors for oxygen requirement in Japanese patients with Coronavirus disease 2019 (COVID-19)","volume":"68","author":"Okauchi","year":"2021","journal-title":"Endocr. J."},{"key":"ref_24","first-page":"29","article-title":"Pathogenesis of Multiple Organ Injury in COVID-19 and Potential Therapeutic Strategies","volume":"12","author":"Silva","year":"2021","journal-title":"Front. Physiol."},{"key":"ref_25","doi-asserted-by":"crossref","first-page":"105954","DOI":"10.1016\/j.ijantimicag.2020.105954","article-title":"Cytokine release syndrome in severe COVID-19: Interleukin-6 receptor antagonist tocilizumab may be the key to reduce mortality","volume":"55","author":"Zhang","year":"2020","journal-title":"Int. J. Antimicrob. Agents"},{"key":"ref_26","doi-asserted-by":"crossref","unstructured":"The RECOVERY Collaborative Group (2021). Dexamethasone in Hospitalized Patients with Covid-19. N. Engl. J. Med., 384, 693\u2013704.","DOI":"10.1056\/NEJMoa2021436"},{"key":"ref_27","doi-asserted-by":"crossref","first-page":"1392","DOI":"10.2337\/dc20-0576","article-title":"Obesity and COVID-19 Severity in a Designated Hospital in Shenzhen, China","volume":"43","author":"Cai","year":"2020","journal-title":"Diabetes Care"},{"key":"ref_28","doi-asserted-by":"crossref","first-page":"257","DOI":"10.1002\/jmv.26237","article-title":"Obesity aggravates COVID-19: A systematic review and meta-analysis","volume":"93","author":"Yang","year":"2021","journal-title":"J. Med. Virol."},{"key":"ref_29","doi-asserted-by":"crossref","first-page":"135","DOI":"10.1161\/CIRCULATIONAHA.120.051936","article-title":"Association of Body Mass Index and Age With Morbidity and Mortality in Patients Hospitalized With COVID-19","volume":"143","author":"Hendren","year":"2021","journal-title":"Circulation"},{"key":"ref_30","doi-asserted-by":"crossref","first-page":"773","DOI":"10.7326\/M20-3742","article-title":"Obesity and Mortality Among Patients Diagnosed With COVID-19: Results from an Integrated Health Care Organization","volume":"173","author":"Tartof","year":"2020","journal-title":"Ann. Intern. Med."},{"key":"ref_31","doi-asserted-by":"crossref","first-page":"1200","DOI":"10.1002\/oby.22859","article-title":"Association of Obesity with Disease Severity Among Patients with Coronavirus Disease 2019","volume":"28","author":"Kalligeros","year":"2020","journal-title":"Obesity"},{"key":"ref_32","doi-asserted-by":"crossref","first-page":"1903","DOI":"10.1161\/CIRCULATIONAHA.120.047349","article-title":"Description and Proposed Management of the Acute COVID-19 Cardiovascular Syndrome","volume":"141","author":"Hendren","year":"2020","journal-title":"Circulation"},{"key":"ref_33","doi-asserted-by":"crossref","first-page":"44","DOI":"10.1136\/thx.2009.117572","article-title":"Body mass index is associated with the development of acute respiratory distress syndrome","volume":"65","author":"Gong","year":"2010","journal-title":"Thorax"},{"key":"ref_34","doi-asserted-by":"crossref","first-page":"1138","DOI":"10.1016\/j.mayocp.2020.04.006","article-title":"Association Between Hypoxemia and Mortality in Patients With COVID-19","volume":"95","author":"Xie","year":"2020","journal-title":"Mayo Clin. Proc."},{"key":"ref_35","doi-asserted-by":"crossref","first-page":"715","DOI":"10.7326\/0003-4819-139-9-200311040-00005","article-title":"Outcomes and prognostic factors in 267 patients with severe acute respiratory syndrome in Hong Kong","volume":"139","author":"Choi","year":"2003","journal-title":"Ann. Intern. Med."},{"key":"ref_36","doi-asserted-by":"crossref","first-page":"286","DOI":"10.1136\/thoraxjnl-2016-209313","article-title":"Predictors of mortality in Middle East respiratory syndrome (MERS)","volume":"73","author":"Hong","year":"2018","journal-title":"Thorax"}],"container-title":["Journal of Clinical Medicine"],"original-title":[],"language":"en","link":[{"URL":"https:\/\/www.mdpi.com\/2077-0383\/10\/16\/3581\/pdf","content-type":"unspecified","content-version":"vor","intended-application":"similarity-checking"}],"deposited":{"date-parts":[[2025,10,11]],"date-time":"2025-10-11T06:46:01Z","timestamp":1760165161000},"score":1,"resource":{"primary":{"URL":"https:\/\/www.mdpi.com\/2077-0383\/10\/16\/3581"}},"subtitle":[],"short-title":[],"issued":{"date-parts":[[2021,8,14]]},"references-count":36,"journal-issue":{"issue":"16","published-online":{"date-parts":[[2021,8]]}},"alternative-id":["jcm10163581"],"URL":"https:\/\/doi.org\/10.3390\/jcm10163581","relation":{},"ISSN":["2077-0383"],"issn-type":[{"value":"2077-0383","type":"electronic"}],"subject":[],"published":{"date-parts":[[2021,8,14]]}}}