Infectious Diseases and COVID-19 Unit, Athens, Greece.
1st Internal Medicine Department, Athens, Greece.
Can Respir J. 2023 Feb 8;2023:7474564. doi: 10.1155/2023/7474564. eCollection 2023.
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.
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.
In univariate analysis, HFNC de-escalation was associated with younger age (59.2 ± 14 vs. 67.7 ± 10.5 and < 0.001), lower levels of serum lactate (1.1 vs. 1.5 and =0.013), and higher ROX-index at 12 hrs (5.09 vs. 4.13 and < 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 < 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 < 0.001), greater creatinine values (0.96 vs. 0.84 and =0.022), greater SOFA score (=0.039), and a lower 12 hrs ROX-index (4.22 vs. 4.95 and =0.02) were associated with hospital mortality. The SOFA score and age retained significance in multivariate survival analysis.
ROX-index is proven to be a valuable and easy-to-use tool for clinicians in the assessment of COVID-19 patients under HFNC.
高流量鼻导管（HFNC）是一种供氧方法，已证明可降低 1 型呼吸衰竭患者插管和死亡的风险。ROX 指数评分可预测 HFNC 失败。本研究旨在评估连续 ROX 指数评估作为 HFNC 失败和死亡率的预测指标。
这是一项包括所有 2020 年 11 月 1 日至 2021 年 5 月 31 日期间因 SARS-CoV-2 PCR 阳性而接受 HFNC 治疗的成年患者的前瞻性观察性单中心研究，排除血流动力学不稳定或无法耐受 HFNC 的患者。主要终点是 HFNC 成功降级。
在单因素分析中，HFNC 降级与年龄较小（59.2±14 岁与 67.7±10.5 岁， < 0.001）、血清乳酸水平较低（1.1 与 1.5，=0.013）和 12 小时时 ROX 指数较高（5.09 与 4.13， < 0.001）相关。12 小时 ROX 指数的 ROC 曲线分析产生了 71.2%的 C 统计量（95%CI 61.6-80.9， < 0.001）。12 小时 ROX 指数和年龄在多因素分析中仍然具有显著性。使用最佳截断点 4.43，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 岁与 58.9±13.9 岁， < 0.001）、肌酐值较高（0.96 与 0.84，=0.022）、SOFA 评分较高（=0.039）和 12 小时 ROX 指数较低（4.22 与 4.95，=0.02）与住院死亡率相关。SOFA 评分和年龄在多因素生存分析中仍然具有显著性。
ROX 指数被证明是评估 COVID-19 患者接受 HFNC 治疗的一种有价值且易于使用的工具。
