比较 ROX、HROX 和 delta-HR 指数预测 COVID-19 肺炎住院患者成功脱高流量氧治疗。
Comparison of ROX, HROX, and delta-HR indices to predict successful weaning from high-flow oxygen therapy in hospitalized patients with COVID-19 pneumonia.
机构信息
Department of Internal Medicine, Division of Pulmonary and Critical Care Medicine, Thammasat University, Klongluang, Pathum Thani, Thailand.
出版信息
PLoS One. 2024 Feb 15;19(2):e0297624. doi: 10.1371/journal.pone.0297624. eCollection 2024.
BACKGROUND
High-flow nasal cannula (HFNC) therapy is commonly used to treat acute respiratory failure in patients with COVID-19 pneumonia. However, predictors of successful weaning from HFNC in these patients has not been investigated.
OBJECTIVE
To assess predictors of successful separation from HFNC in patients with COVID-19 pneumonia.
METHODS
We conducted a retrospective cohort study at a university hospital in Thailand. Patients with COVID-19 pneumonia requiring HFNC therapy between April 2020 and June 2022 were included. ROX index was defined as the ratio of oxygen saturation (SpO2) / fraction of inspired oxygen (FiO2) to respiratory rate. Heart-ROX (HROX) index was defined as ROX multiplied by heart rate (HR) improvement. HR improvement (delta-HR) was defined as a percentage of the difference between the baseline HR and the morning HR at HFNC weaning day 1 divided by the baseline HR. Weaning success was defined as ability to sustain spontaneous breathing after separation from HFNC without any invasive or non-invasive ventilatory support for ≥48 hours or death.
RESULTS
A total of 164 patients (54% male) were included. Mean age was 61.1±16.1 years. Baseline SpO2/FiO2 was 265.3±110.8. HFNC weaning success was 77.4%. The best cut-off value of ROX index to predict HFNC weaning success was 7.88 with 100% sensitivity, 97.3% specificity, and area under the ROC curve (AUC) of 0.98 (95% CI: 0.937-1.000, p<0.001). The best cut-off value of delta-HR 3.7 with 88.2% sensitivity, 75.7% specificity, and AUC of 0.83 (95% CI: 0.748-0.919, p<0.001). The best cut-off value of HROX index was 59.2 with 88.2% sensitivity, 81.1% specificity, and AUC of 0.89, (95% CI: 0.835-0.953, p<0.001).
CONCLUSIONS
The ROX index has the highest accuracy for predicting successful weaning off HFNC treatment in patients with COVID-19 pneumonia. While HROX and delta-HR indices can serve as alternative tools, it is recommended to verify these indices and determine the optimal cut-off value for determining separation from HFNC therapy through a large prospective cohort study.
TRIAL REGISTRATION
Clinicaltrials.in.th number: TCTR20221108004.
背景
高流量鼻导管（HFNC）治疗常用于治疗 COVID-19 肺炎患者的急性呼吸衰竭。然而，尚未研究这些患者从 HFNC 成功撤机的预测因素。
目的
评估 COVID-19 肺炎患者从 HFNC 成功分离的预测因素。
方法
我们在泰国的一所大学医院进行了一项回顾性队列研究。纳入 2020 年 4 月至 2022 年 6 月期间需要 HFNC 治疗的 COVID-19 肺炎患者。ROX 指数定义为氧饱和度（SpO2）/吸入氧分数（FiO2）与呼吸率的比值。心脏-ROX（HROX）指数定义为 ROX 乘以心率（HR）改善。HR 改善（delta-HR）定义为基础 HR 与 HFNC 撤机第 1 天早晨 HR 之间的差异百分比除以基础 HR。撤机成功定义为在不使用任何有创或无创通气支持的情况下，从 HFNC 分离后能够维持自主呼吸≥48 小时或死亡。
结果
共纳入 164 例患者（54%为男性）。平均年龄为 61.1±16.1 岁。基线 SpO2/FiO2 为 265.3±110.8。HFNC 撤机成功率为 77.4%。预测 HFNC 撤机成功的最佳 ROX 指数截断值为 7.88，具有 100%的灵敏度、97.3%的特异性和 0.98 的 ROC 曲线下面积（95%CI：0.937-1.000，p<0.001）。最佳 delta-HR 截断值为 3.7，灵敏度为 88.2%，特异性为 75.7%，曲线下面积为 0.83（95%CI：0.748-0.919，p<0.001）。最佳 HROX 指数截断值为 59.2，灵敏度为 88.2%，特异性为 81.1%，曲线下面积为 0.89（95%CI：0.835-0.953，p<0.001）。
结论
ROX 指数在预测 COVID-19 肺炎患者 HFNC 治疗撤机成功方面具有最高的准确性。虽然 HROX 和 delta-HR 指数可以作为替代工具，但建议通过大型前瞻性队列研究验证这些指数并确定确定与 HFNC 治疗分离的最佳截断值。
临床试验注册
Clinicaltrials.in.th 编号：TCTR20221108004。
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