Department of Respiratory Medicine, Kobe City Medical Center General Hospital, 2-1-1 Minatojima-Minamimachi, Chuo-Ku, Kobe, Hyogo, 650-0047, Japan.
Department of Infectious Disease, Kobe City Medical Center General Hospital, Kobe, Hyogo, Japan.
BMC Pulm Med. 2023 Aug 10;23(1):294. doi: 10.1186/s12890-023-02598-y.
High-flow nasal cannula (HFNC) therapy is an important non-invasive respiratory support in acute respiratory failure, including coronavirus disease (COVID-19) pneumonia. Although the respiratory rate and oxygenation (ROX) index is a simple and useful predictor for HFNC failure and mortality, there is limited evidence for its use in patients with COVID-19 pneumonia. We aimed to evaluate the ROX index as a predictor for HFNC failure in patients with COVID-19 pneumonia. We also evaluated the ROX index as a predictor for 28-day mortality.
In this single-center, retrospective, cohort study, 248 patients older than 18 years of age with COVID-19 pneumonia received HFNC therapy for acute respiratory failure. The ROX index was evaluated within 4 h from the start of HFNC therapy. Past medical history, laboratory data, and the ROX index were evaluated as predictors for HFNC failure and 28-day mortality.
The ROX index < 4.88 showed a significantly high risk ratio for HFNC failure (2.13 [95% confidence interval [CI]: 1.47 - 3.08], p < 0.001). The ROX index < 4.88 was significantly associated with 28-day mortality (p = 0.049) in patients with COVID-19 pneumonia receiving HFNC therapy. Age, chronic hypertension, high lactate dehydrogenase level, and low ROX index showed significantly high risk ratio for HFNC failure. C-reactive protein level and low ROX index were predictors of 28-day morality.
The ROX index is a useful predictor for HFNC success and 28-day mortality in patients with COVID-19 pneumonia receiving HFNC therapy.
An independent ethics committee approved the study (Research Ethics Review Committee of Kobe City Medical Center General Hospital [number: zn220303; date: February 21, 2022]), which was performed in accordance with the Declaration of Helsinki, Guidelines for Good Clinical Practice.
高流量鼻导管（HFNC）治疗是急性呼吸衰竭的重要非侵入性呼吸支持手段，包括冠状病毒病（COVID-19）肺炎。虽然呼吸频率和氧合指数（ROX）是预测 HFNC 治疗失败和死亡率的简单而有用的指标，但在 COVID-19 肺炎患者中应用该指标的证据有限。我们旨在评估 ROX 指数作为预测 COVID-19 肺炎患者 HFNC 治疗失败的指标。我们还评估了 ROX 指数作为预测 28 天死亡率的指标。
在这项单中心、回顾性队列研究中，248 名年龄大于 18 岁的 COVID-19 肺炎患者因急性呼吸衰竭接受 HFNC 治疗。HFNC 治疗开始后 4 小时内评估 ROX 指数。既往病史、实验室数据和 ROX 指数被评估为 HFNC 治疗失败和 28 天死亡率的预测指标。
ROX 指数<4.88 与 HFNC 治疗失败的高风险比显著相关（2.13 [95%置信区间（CI）：1.47-3.08]，p<0.001）。在接受 HFNC 治疗的 COVID-19 肺炎患者中，ROX 指数<4.88 与 28 天死亡率显著相关（p=0.049）。年龄、慢性高血压、高乳酸脱氢酶水平和低 ROX 指数与 HFNC 治疗失败的高风险比显著相关。C 反应蛋白水平和低 ROX 指数是 28 天死亡率的预测指标。
ROX 指数是预测 COVID-19 肺炎患者 HFNC 治疗成功和 28 天死亡率的有用指标。
独立伦理委员会批准了这项研究（神户市医疗中心总医院研究伦理审查委员会[编号：zn220303；日期：2022 年 2 月 21 日]），该研究符合《赫尔辛基宣言》和《良好临床实践指南》。
