Validation of Sequential ROX-Index Score Beyond 12 Hours in Predicting Treatment Failure and Mortality in COVID-19 Patients Receiving Oxygen via High-Flow Nasal Cannula.

IF 2.1 4区医学 Q3 RESPIRATORY SYSTEM

Canadian respiratory journal Pub Date : 2023-01-01 DOI:10.1155/2023/7474564

Dimitris Basoulis, Pantelis Avramopoulos, Maria Aggelara, Georgios Karamanakos, Pantazis-Michail Voutsinas, Amalia Karapanou, Mina Psichogiou, Michalis Samarkos, Foteini Ntziora, Nikolaos V Sipsas

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引用次数: 2

Abstract

Background: High-flow nasal cannula (HFNC) is an oxygen delivery method shown to reduce the risk of intubation and mortality in patients with type 1 respiratory failure. The ROX-index score can predict HFNC failure. This study aims to evaluate sequential ROX-index assessments as predictors of HFNC failure and mortality.

Methods: Prospective observational single-center study including all adult patients with positive SARS-CoV-2 PCR placed under HFNC from 1st November 2020 to 31st May 2021, and patients with hemodynamic instability or unable to tolerate HFNC were excluded. The primary endpoint was successful HFNC de-escalation.

Results: In univariate analysis, HFNC de-escalation was associated with younger age (59.2 ± 14 vs. 67.7 ± 10.5 and p < 0.001), lower levels of serum lactate (1.1 vs. 1.5 and p=0.013), and higher ROX-index at 12 hrs (5.09 vs. 4.13 and p < 0.001). ROC curve analysis of ROX-index at 12 hrs yielded a c-statistic of 71.2% (95% CI 61.6-80.9 and p < 0.001). ROX-index at 12 hrs and age retained significance in multivariate analysis. Using an optimal cutoff point of 4.43, we calculated a sensitivity of 64.5% and specificity of 69.6%. In univariate survival analysis, older age (68.8 ± 9.7 vs. 58.9 ± 13.9 and p < 0.001), greater creatinine values (0.96 vs. 0.84 and p=0.022), greater SOFA score (p=0.039), and a lower 12 hrs ROX-index (4.22 vs. 4.95 and p=0.02) were associated with hospital mortality. The SOFA score and age retained significance in multivariate survival analysis.

Conclusion: ROX-index is proven to be a valuable and easy-to-use tool for clinicians in the assessment of COVID-19 patients under HFNC.

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查看原文本刊更多论文

12小时后序列ROX-Index评分预测高流量鼻插管供氧患者治疗失败和死亡率的验证

背景:高流量鼻插管(HFNC)是一种供氧方法，可降低1型呼吸衰竭患者的插管风险和死亡率。ROX-index评分可预测HFNC失败。本研究旨在评估顺序rox指数评估作为HFNC失败和死亡率的预测因子。方法:前瞻性观察性单中心研究，纳入2020年11月1日至2021年5月31日在HFNC下放置的所有SARS-CoV-2 PCR阳性的成年患者，排除血液动力学不稳定或不能耐受HFNC的患者。主要终点是HFNC降级成功。结果:在单因素分析中，HFNC降级与年龄较小(59.2±14比67.7±10.5,p < 0.001)、血清乳酸水平较低(1.1比1.5,p=0.013)、12小时rox指数较高(5.09比4.13,p < 0.001)相关。ROC曲线分析12小时rox指数的c统计量为71.2% (95% CI 61.6 ~ 80.9, p < 0.001)。12小时rox指数和年龄在多变量分析中保持显著性。使用4.43的最佳截断点，我们计算出敏感性为64.5%，特异性为69.6%。在单因素生存分析中，年龄较大(68.8±9.7比58.9±13.9,p < 0.001)、肌酐值较大(0.96比0.84,p=0.022)、SOFA评分较高(p=0.039)、12小时rox指数较低(4.22比4.95,p=0.02)与住院死亡率相关。SOFA评分和年龄在多变量生存分析中仍具有重要意义。结论:ROX-index是临床医生在HFNC下评估COVID-19患者的一种有价值且易于使用的工具。

本文章由计算机程序翻译，如有差异，请以英文原文为准。

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来源期刊

Canadian respiratory journal 医学-呼吸系统

CiteScore

4.20

自引率

0.00%

发文量

审稿时长

6-12 weeks

期刊介绍： Canadian Respiratory Journal is a peer-reviewed, Open Access journal that aims to provide a multidisciplinary forum for research in all areas of respiratory medicine. The journal publishes original research articles, review articles, and clinical studies related to asthma, allergy, COPD, non-invasive ventilation, therapeutic intervention, lung cancer, airway and lung infections, as well as any other respiratory diseases.