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Mortality risk of hypoxaemic acute respiratory failure among Indonesians: A systematic review and meta-analysis Cover

Mortality risk of hypoxaemic acute respiratory failure among Indonesians: A systematic review and meta-analysis

Pneumologia
Volume 74 (2025): Issue 1 (January 2025)
By:
Open Access
|Sep 2025

Figures & Tables

Figure 1.

PRISMA 2020 flow diagram of study selection. PRISMA, preferred reporting items for systematic reviews and meta-analyses.
PRISMA 2020 flow diagram of study selection. PRISMA, preferred reporting items for systematic reviews and meta-analyses.

Figure 2.

Forest plot of mortality risk among hypoxaemic ARF. ARF, acute respiratory failure; CI, confidence interval.
Forest plot of mortality risk among hypoxaemic ARF. ARF, acute respiratory failure; CI, confidence interval.

Figure 3.

Subgroup analysis of mortality risk among hypoxaemic ARF in the pre-pandemic era. ARF, acute respiratory failure; CI, confidence interval.
Subgroup analysis of mortality risk among hypoxaemic ARF in the pre-pandemic era. ARF, acute respiratory failure; CI, confidence interval.

Figure 4.

Subgroup analysis of mortality risk among hypoxaemic ARF in the pandemic era. ARF, acute respiratory failure; CI, confidence interval.
Subgroup analysis of mortality risk among hypoxaemic ARF in the pandemic era. ARF, acute respiratory failure; CI, confidence interval.

Full search terms for journal databases_

DatabaseKeyword
MEDLINE((“hypoxaemia”[All Fields] OR “hypoxia”[MeSH Terms] OR “hypoxia”[All Fields] OR “hypoxemia”[All Fields] OR “hypoxemias”[All Fields] OR (“hypoxaemia”[All Fields] OR “hypoxia”[MeSH Terms] OR “hypoxia”[All Fields] OR “hypoxemia”[All Fields] OR “hypoxemias”[All Fields]) OR (“hypoxia”[MeSH Terms] OR “hypoxia”[All Fields] OR “hypoxias”[All Fields] OR “hypoxias”[All Fields]) OR (‘hypoxia”[MeSH Terms] OR ‘hypoxia”[All Fields] OR ‘anoxemia”[All Fields]) OR (‘hypoxia”[MeSH Terms] OR “hypoxia”[All Fields] OR “anoxia”[All Fields]) OR (“hypoxia”[MeSH Terms] OR “hypoxia”[All Fields] OR (“oxygen”[All Fields] AND “deficiencies”[All Fields]) OR “oxygen deficiencies”[All Fields]) OR (“hypoxia”[MeSH Terms] OR “hypoxia”[All Fields] OR (“oxygen”[All Fields] AND “deficiency”[All Fields]) OR “oxygen deficiency”[All Fields])) AND (Indonesia)) AND ((((((((Prevalence) OR (Prevalences)) OR (Period Prevalences)) OR (Period Prevalence)) OR (Point Prevalences)) OR (Point Prevalence)) OR (((((((((((((((Incidence) OR (Secondary Attack Rate)) OR (Secondary Attack Rates)) OR (Cumulative Incidence)) OR (Cumulative Incidences)) OR (Attack Rates)) OR (Attack Rate)) OR (Incidence Proportion)) OR (Incidence Proportions)) OR (Incidences)) OR (Person-time Rate)) OR (Incidence Rate)) OR (Person time Rate)) OR (Incidence Rates)) OR (Person-time Rates))) OR ((((((((((((((((((((((((Mortality risk) OR (Age-Specific Death Rate)) OR (Age-Specific Death Rates)) OR (Age Specific Death Rate)) OR (Excess Mortality)) OR (Excess Mortalities)) OR (Mortality Determinant)) OR (Mortality Determinants)) OR (Differential Mortality)) OR (Differential Mortalities)) OR (CFR Case Fatality Rate)) OR (Case Fatality Rate)) OR (Case Fatality Rates)) OR (Mortalities)) OR (Crude Death Rate)) OR (Crude Mortality Rates)) OR (Crude Death Rates)) OR (Crude Mortality Rate)) OR (Mortality Rate)) OR (Mortality Rates)) OR (Death Rate)) OR (Death Rates)) OR (Mortality Declines)) OR (Mortality Decline)))
Embase#1Hypoxaemia OR Hypoxemia OR Hypoxia OR Anoxemia OR Anoxia OR ‘Oxygen Deficiencies’ OR ‘Oxygen Deficiency’
#2Prevalence OR Prevalences OR ‘Period Prevalences’ OR ‘Period Prevalence’ OR ‘Prevalence, Period’ OR ‘Point Prevalences’ OR ‘Prevalence, Point’ OR ‘Point Prevalence’
#3Incidence OR ‘Secondary Attack Rate’ OR ‘Rate, Secondary Attack’ OR ‘Secondary Attack Rates’ OR ‘Attack Rate, Secondary’ OR ‘Proportion, Incidence’ OR ‘Incidence, Cumulative’ OR ‘Cumulative Incidence’ OR ‘Cumulative Incidences’ OR ‘Attack Rates’ OR ‘Attack Rate’ OR ‘Incidence Proportion’ OR ‘Incidence Proportions’ OR ‘Rate, Attack’ OR Incidences OR ‘Person-time Rate’ OR ‘Rate, Incidence’ OR ‘Incidence Rate’ OR ‘Rate, Person-time’ OR ‘Person time Rate’ OR ‘Incidence Rates’ OR ‘Person-time Rates’
#4‘Mortality risk’ OR ‘Age-Specific Death Rate’ OR ‘Death Rate, Age-Specific’ OR ‘Age-Specific Death Rates’ OR ‘Age Specific Death Rate’ OR ‘Rate, Age-Specific Death’ OR ‘Excess Mortality’ OR ‘Excess Mortalities’ OR ‘Mortality, Excess’ OR ‘Mortality Determinant’ OR ‘Determinants, Mortality’ OR ‘Mortality Determinants’ OR ‘Determinant, Mortality’ OR ‘Mortality, Differential’ OR ‘Differential Mortality’ OR ‘Differential Mortalities’ OR ‘Rates, Case Fatality’ OR ‘CFR’ OR ‘Case Fatality Rate’ OR ‘Rate, Case Fatality’ OR ‘Case Fatality Rate’ OR ‘Case Fatality Rates’ OR Mortalities OR ‘Crude Death Rate’ OR ‘Crude Mortality Rates’ OR ‘Rate, Crude Death’ OR ‘Crude Death Rates’ OR ‘Death Rate, Crude’ OR ‘Mortality Rate, Crude’ OR ‘Crude Mortality Rate’ OR ‘Rate, Crude Mortality’ OR ‘Mortality Rate’ OR ‘Rate, Death’ OR ‘Mortality Rates’ OR ‘Death Rate’ OR ‘Rate, Mortality’ OR ‘Death Rates’ OR ‘Mortality Declines’ OR ‘Decline, Mortality’ OR ‘Mortality Decline’
#5#2 OR #3 OR #4
#6Indonesia
#1 AND #5 AND #6
CENTRAL#1((((((Hypoxaemia) OR (Hypoxemia)) OR (Hypoxia)) OR (Anoxemia)) OR (Anoxia)) OR (Oxygen Deficiencies)) OR (Oxygen Deficiency)
#2Indonesia
#3(((((Prevalence) OR (Prevalences)) OR (Period Prevalences)) OR (Period Prevalence)) OR (Point Prevalences)) OR (Point Prevalence)
#4((((((((((((((Incidence) OR (Secondary Attack Rate)) OR (Secondary Attack Rates)) OR (Cumulative Incidence)) OR (Cumulative Incidences)) OR (Attack Rates)) OR (Attack Rate)) OR (Incidence Proportion)) OR (Incidence Proportions)) OR (Incidences)) OR(Person-time Rate)) OR (Incidence Rate)) OR (Person time Rate)) OR (Incidence Rates)) OR (Person-time Rates)
#5(((((((((((((((((((((((Mortality risk) OR (Age-Specific Death Rate)) OR (Age-Specific Death Rates)) OR (Age Specific Death Rate)) OR (Excess Mortality)) OR (Excess Mortalities)) OR (Mortality Determinant)) OR (Mortality Determinants)) OR (Differential Mortality)) OR (Differential Mortalities)) OR (CFR Case Fatality Rate)) OR (Case Fatality Rate)) OR (Case Fatality Rates)) OR (Mortalities)) OR (Crude Death Rate)) OR (Crude Mortality Rates)) OR (Crude Death Rates)) OR (Crude Mortality Rate)) OR (Mortality Rate)) OR (Mortality Rates)) OR (Death Rate)) OR (Death Rates)) OR (Mortality Declines)) OR (Mortality Decline)
#6(((((((Prevalence) OR (Prevalences)) OR (Period Prevalences)) OR (Period Prevalence)) OR (Point Prevalences)) OR (Point Prevalence)) OR (((((((((((((((Incidence) OR (Secondary Attack Rate)) OR (Secondary Attack Rates)) OR (Cumulative Incidence)) OR (Cumulative Incidences)) OR (Attack Rates)) OR (Attack Rate)) OR (Incidence Proportion)) OR (Incidence Proportions)) OR (Incidences)) OR (Person-time Rate)) OR (Incidence Rate)) OR (Person time Rate)) OR (Incidence Rates)) OR (Person-time Rates))) OR ((((((((((((((((((((((((Mortality risk) OR (Age-Specific Death Rate)) OR (Age-Specific Death Rates)) OR (Age Specific Death Rate)) OR (Excess Mortality)) OR (Excess Mortalities)) OR (Mortality Determinant)) OR (Mortality Determinants)) OR (Differential Mortality)) OR (Differential Mortalities)) OR (CFR Case Fatality Rate)) OR (Case Fatality Rate)) OR (Case Fatality Rates)) OR (Mortalities)) OR (Crude Death Rate)) OR (Crude Mortality Rates)) OR (Crude Death Rates)) OR (Crude Mortality Rate)) OR (Mortality Rate)) OR (Mortality Rates)) OR (Death Rate)) OR (Death Rates)) OR (Mortality Declines)) OR (Mortality Decline))
#1 AND #2 AND #6
Scopus(ALL((Hypoxaemia OR Hypoxemia OR Hypoxia OR Anoxemia OR Anoxia OR (Oxygen Deficiencies) OR (Oxygen Deficiency))) AND ALL((Prevalence OR Prevalences OR (Period Prevalences) OR (Period Prevalence) OR (Prevalence, Period) OR (Point Prevalences) OR (Prevalence, Point) OR (Point Prevalence) OR Incidence OR (Secondary Attack Rate) OR (Rate, Secondary Attack) OR (Secondary Attack Rates) OR (Attack Rate, Secondary) OR (Proportion, Incidence) OR (Incidence, Cumulative) OR (Cumulative Incidence) OR (Cumulative Incidences) OR (Attack Rates) OR (Attack Rate) OR (Incidence Proportion) OR (Incidence Proportions) OR (Rate, Attack) OR Incidences OR (Person-time Rate) OR (Rate, Incidence) OR (Incidence Rate) OR (Rate, Person-time) OR (Person time Rate) OR (Incidence Rates) OR (Person-time Rates) OR (Mortality risk) OR (Age-Specific Death Rate) OR (Death Rate, Age-Specific) OR (Age-Specific Death Rates) OR (Age Specific Death Rate) OR (Rate, Age-Specific Death) OR (Excess Mortality) OR (Excess Mortalities) OR (Mortality, Excess) OR (Mortality Determinant) OR (Determinants, Mortality) OR (Mortality Determinants) OR (Determinant, Mortality) OR (Mortality, Differential) OR (Differential Mortality) OR (Differential Mortalities) OR (Rates, Case Fatality) OR (CFR) OR (Case Fatality Rate) OR (Rate, Case Fatality) OR (Case Fatality Rate) OR (Case Fatality Rates) OR Mortalities OR (Crude Death Rate) OR (Crude Mortality Rates) OR (Rate, Crude Death) OR (Crude Death Rates) OR (Death Rate, Crude) OR (Mortality Rate, Crude) OR (Crude Mortality Rate) OR (Rate, Crude Mortality) OR (Mortality Rate) OR (Rate, Death) OR (Mortality Rates) OR (Death Rate) OR (Rate, Mortality) OR (Death Rates) OR (Mortality Declines) OR (Decline, Mortality) OR (Mortality Decline))) AND ALL(Indonesia))

Study characteristics table for included studies assessing mortality risk_

No.Author, yearLocationData collection timeSample size (hypoxaemia patients)PopulationMean (SD)/median (range) age (years)Definition of ARFCause of ARFFindings
Frequency of the non-surv¡ved groupFrequency of the survived groupPercentage (%)
1Amin et al. (2016) (15)JakartaOctober 2015–August 2016101Patients aged >18 years, diagnosed with ARDS by Berlin criteria52.7 (17.2)PaO2/FiO2≤300Not specifiedMild ARDS: 16 Moderate ARDS: 22 Severe ARDS: 15 Total: 53Mild ARDS: 28 Moderate ARDS: 14 Severe ARDS: 6 Total: 48Mild ARDS: 36.4 Moderate ARDS: 61.1 Severe ARDS: 71.4 Total: 52.48
2Elhidsi et al. (2021) (16)JakartaJanuary 2017–December 2018111Patients aged ≥18 years, diagnosed with ARF caused by pulmonary tuberculosisN/APaO2 < 60 mmHg, SpO2<91% and PaO2/FiO2<300Tuberculosis535847.75
3Made Reditya Noviyani et al. (2020) (17)BaliJanuary 2018–December 201960Children with ARDS admitted in the PICU during the data collection periodARDSp: 2 (1–180) monthsARDSexp: 6 (1–144) monthsPaO2/FiO2<300Not specifiedARDSp: 10 ARDSexp: 22 Total: 32ARDSp: 20 ARDSexp: 8 Total: 28ARDSp: 33.3 ARDSexp: 73.3 Total: 53.33
4Nugraha et al. (2022) (18)East JavaJuly–December 202078Patients with the age of ≥18 years, confirmed COVID-19 by PCR test and the PaO2/FiO2 ratio of <300 mmHg were included.47.75 (±13.39) yearsPaO2/FiO2 < 300COVID-19Mild ARDS: 1 Moderate ARDS: 9 Severe ARDS: 10 Total: 20Mild ARDS: 9 Moderate ARDS: 36 Severe ARDS: 13 Total: 58Mild ARDS: 5 Moderate ARDS: 45 Severe ARDS: 50
5Nugrahani et al. (2022) (14)Central JavaNovember 2020–September 202143Patients diagnosed with COVID-19 during the data collection periodN/ASpO2 < 90%COVID-19311272
6Rasmin et al. (2018) (8)JakartaJanuary–December 201569Patients aged >18 years, diagnosed with ARF51 (15–92) yearsPaO2 < 60 mmHg, SaO2 < 91%, PaO2/FiO2 < 300Not specified284140.58
7Rasmin et al. (2021) (10)Jakarta East Java West Sumatera AcehJanuary–December 2017228Patients aged >17 years, diagnosed with ARF56 (20–90)PaO2<60 mmHg SaO2< 91% PaO2/FiO2<300Not specified10312545.17
8Valentania et al. (2021) (19)West JavaMay 2020–September 202067Patients aged 1 month–18 years with pneumonia23.5 (1–210) monthsSpO2< 90%Pneumonia155222.3

JBI risk of bias assessment of prevalence studies_

No.Author, yearOutcomeWas the sample frame appropriate to address the target population?Were study participants sampled in an appropriate way?Was the sample size adequate?Were the study subjects and the setting described in detail?Was the data analysis conducted with sufficient coverage of the identified sample?Were valid methods used for the identification of the condition?Was the condition measured in a standard, reliable way for all participants?Was there an appropriate statistical analysis?Was the response rate adequate, and if not, was the low response rate managed appropriately?Overall appraisal
1Amin et al. (2016) (15)Mortality riskYesYesYesYesYesYesYesYesYesInclude
2Elhidsi et al. (2021) (16)Mortality riskYesYesYesYesYesYesYesYesYesInclude
3Made Reditya Noviyani et al., (2020) (17)Mortality riskYesYesYesYesYesYesYesYesYesInclude
4Nugraha et al. (2022) (18)Mortality riskYesYesYesYesYesYesYesYesYesInclude
5Nugrahani and Fauzi (2022) (14)Prevalence/incidence, mortality riskYesYesNoYesYesUnclearUnclearYesYesExcluded from quantitative analysis due to inadequate sample size
6Rasmin et al. (2018) (8)Mortality riskYesUnclearYesYesYesYesYesYesYesInclude
7Rasmin et al. (2021) (10)Mortality riskYesUnclearYesYesYesYesYesYesYesInclude
8Valentania et al. (2021) (19)Prevalence/incidence, mortality riskYesYesYesYesYesYesYesYesYesInclude

Hospital setting and details of mortality risk_

No.Author, yearHospital setting and measurement processDefinition of mortality
1Amin et al. (2016) (15)Hospital setting: Single point, unspecified inpatient settingTreatment prior to measurement: YesMeasurement process: arterial blood gas testAdditional information: -- Mortality type by cause: cause-specific mortality- Mortality type by interval: 28-day mortality
2Elhidsi and Rasmin (2021) (16)Hospital setting: unspecified point at EDTreatment prior to measurement: YesMeasurement process: pulse oximetry and arterial blood gas testAdditional information: -- Mortality type by cause: cause-specific mortality, in-hospital mortality- Mortality type by interval: 30-day mortality
3Made Reditya Noviyani et al. (2020) (17)Hospital setting: Single point at the PICUTreatment prior to measurement: YesMeasurement process: pulse oximetry or arterial blood gas testAdditional information: -- Mortality type by cause: cause-specific mortality- Mortality type by interval: N/A
4Nugraha et al. (2022) (18)Hospital setting: Single point at ICUTreatment prior to measurement: YesMeasurement process: arterial blood gas testAdditional information: -- Mortality type by cause: cause-specific mortality- Mortality type by interval: 28-day mortality
5Nugrahani and Fauzi (2022) (14)Hospital setting: unspecified point, Non-ICU and ICU settingTreatment prior to measurement: N/AMeasurement process: pulse oximetryAdditional information: -- Mortality type by cause: cause-specific mortality- Mortality type by interval: N/A
6Rasmin et al. (2018) (8)Hospital setting: unspecified point, unspecified inpatient settingTreatment prior to measurement: YesMeasurement process: arterial blood gas testAdditional information: -- Mortality type by cause: cause-specific mortality, in-hospital mortality- Mortality type by interval: N/A
7Rasmin et al. (2021) (10)Hospital setting: Single point, unspecified inpatient settingbTreatment prior to measurement: Yes (initial treatment at the ED)Measurement process: pulse oximetry and arterial blood gas testAdditional information: -- Cause of the mortality: cause-specific mortality, in-hospital mortality- Interval of mortality: unspecified interval
8Valentania et al. (2021) (19)Hospital setting: Single point, unspecified inpatient settingTreatment prior to measurement: N/AMeasurement process: Pulse oximetryAdditional information: -- Cause of the mortality: cause-specific mortality, in-hospital mortality- Interval of mortality: unspecified interval
DOI: https://doi.org/10.2478/pneum-2025-0022 | Journal eISSN: 2247-059X | Journal ISSN: 2067-2993
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Language: English
Page range: 5 - 18
Published on: Sep 8, 2025
Published by: Romanian Society of Pneumology
In partnership with: Paradigm Publishing Services
Publication frequency: 1 times per year
Keywords:
acute respiratory failure,
hypoxaemia,
mortality,
Indonesia,
oxygen security
Related subjects:
Medicine,
Clinical medicine,
Clinical medicine, other,
Internal medicine,
Pneumology

© 2025 Menaldi Rasmin, Dicky Soehadirman, Ahmad Fadhil Ilham, Gabrielle Adani, Salsabila Rezkia Andini, Elvan Wiyarta, Erlina Burhan, published by Romanian Society of Pneumology
This work is licensed under the Creative Commons Attribution-NonCommercial-NoDerivatives 4.0 License.

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