Abstract
Background/Objectives: The effective management of acute illnesses like COVID-19 requires tools to dynamically assess a patient's resilience to health stressors. This study evaluates novel dynamic biomarkers from continuous blood oxygen saturation (SpO(2)) monitoring, exploring their association with patient outcomes to support clinical decision making. Methods: We examined 200 hospital admissions from 181 adults diagnosed with COVID-19. Two dynamic biomarkers reflecting the homeostatic regulation efficiency of SpO(2) were developed to assess their association with adverse hospital outcomes, specifically ICU admission or death, using binary logistic regressions. The resilience exponent α recorded the relative frequency of prolonged SpO(2) declines, while O(2) challenges quantified the dynamic response to changes in O(2) supplementation. Results: Increased resilience exponent α corresponded to decreased odds of adverse outcomes (OR [95% CI] = 0.59 [0.37-0.93], p = 0.03). Larger SpO(2) increases in response to O(2) supplementation were associated with increased odds of adverse outcomes (OR [95% CI] = 1.40 [1.04-1.83], p = 0.03). Additionally, the number of O(2) supplementation increases (OR [95% CI] = 2.91 [1.90-4.49]) and decreases (OR [95% CI] = 0.33 [0.20-0.55]) during hospitalization were independently linked to poorer and improved outcomes, respectively (both p < 0.001). Conclusions: The resilience exponent α and the O(2) challenge response provide insights into the dynamic regulation of SpO(2), reflecting physical resilience in COVID-19 patients. Continuous SpO(2) monitoring in acute care settings could support more informed clinical decisions during patient management.