Raimondi Federico, Centanni Stefano, Luppi Fabrizio, Aliberti Stefano, Blasi Francesco, Rogliani Paola, Micheletto Claudio, Contoli Marco, Sanduzzi Zamparelli Alessandro, Bocchino Marialuisa, Busatto Paolo, Novelli Luca, Pappacena Simone, Malandrino Luca, Lorini Giorgio, Carioli Greta, Di Marco Fabiano
Respiratory Medicine Unit, ASST Papa Giovanni XXIII, Bergamo.
Respiratory Medicine Unit, ASST Santi Paolo e Carlo, Milan; University of Milan.
Monaldi Arch Chest Dis. 2024 Dec 31;94(4). doi: 10.4081/monaldi.2024.3033. Epub 2024 Oct 24.
Predictors of outcomes are essential to identifying severe COVID-19 cases and optimizing treatment and care settings. The respiratory rate-oxygenation (ROX) index, originally introduced for predicting the failure of non-invasive support in acute hypoxemic respiratory failure (AHRF), has not been extensively studied over time during hospitalization. This multicenter prospective observational study analyzed COVID-19-related AHRF patients admitted to eight Italian hospitals during the second pandemic wave. The study assessed the ROX index using receiver operator characteristic curves and areas under the curve with 95% confidence intervals to predict treatment failure, defined as endotracheal intubation (ETI) or death. A total of 227 patients (69.2% males) were enrolled, with a median arterial partial pressure of oxygen (PaO2)/fraction of inspired oxygen (FIO2) ratio at admission of 248 (interquartile range: 170-295). Nearly one-third (29.5%) required ETI or died during hospitalization. Those who experienced treatment failure were older (median age 70 vs. 61 years, p<0.001), more likely to be current or former smokers (8.5% vs. 6.4% and 42.4% vs. 25.5%, p=0.039), had a higher prevalence of cardiovascular diseases (74.6% vs. 46.3%, p<0.001), and had a lower PaO2/FIO2 ratio at presentation (median 229 vs. 254, p=0.014). Gender, body mass index, and other comorbidities showed no significant differences. In patients who failed treatment, the ROX index was higher at presentation and worsened sharply by days 3 and 4. Conversely, in patients who survived without requiring ETI, the ROX index remained stable and reduced after 5-6 days. The ROX index's predictive ability improved notably by day 3 of hospitalization, with the best cut-off value identified at 8.53 (sensitivity 75%, specificity 68%). Kaplan-Meier curves indicated that a ROX index of 8.53 or lower on days 1, 2, or 3 was associated with a higher risk of treatment failure. Thus, a single ROX index assessment on day 3 is more informative than its variability over time, with values of 8.53 or lower predicting non-invasive respiratory support failure in hospitalized COVID-19 patients.
预后预测指标对于识别重症 COVID-19 病例以及优化治疗和护理环境至关重要。呼吸频率-氧合（ROX）指数最初用于预测急性低氧性呼吸衰竭（AHRF）中无创支持的失败情况，但在住院期间尚未得到广泛的长期研究。这项多中心前瞻性观察性研究分析了在第二波疫情期间入住八家意大利医院的 COVID-19 相关 AHRF 患者。该研究使用受试者工作特征曲线和曲线下面积以及 95%置信区间来评估 ROX 指数，以预测治疗失败，治疗失败定义为气管插管（ETI）或死亡。共纳入 227 例患者（69.2%为男性），入院时动脉血氧分压（PaO2）/吸入氧分数（FIO2）比值的中位数为 248（四分位间距：170 - 295）。近三分之一（29.5%）的患者在住院期间需要 ETI 或死亡。经历治疗失败的患者年龄更大（中位年龄 70 岁对 61 岁，p<0.001），更有可能是当前或既往吸烟者（8.5%对 6.4%以及 42.4%对 25.5%，p = 0.039），心血管疾病患病率更高（74.6%对 46.3%，p<0.001），且就诊时 PaO2/FIO2 比值更低（中位数 229 对 254，p = 0.014）。性别、体重指数和其他合并症无显著差异。在治疗失败的患者中，就诊时 ROX 指数较高，在第 3 天和第 4 天急剧恶化。相反，在无需 ETI 存活的患者中，ROX 指数保持稳定并在 5 - 6 天后降低。住院第 3 天时 ROX 指数的预测能力显著提高，最佳截断值确定为 8.53（敏感性 75%，特异性 68%）。Kaplan-Meier 曲线表明，第 1、2 或 3 天 ROX 指数为 8.53 或更低与治疗失败风险较高相关。因此，第 3 天进行一次 ROX 指数评估比其随时间的变化更具信息量，ROX 指数值为 8.53 或更低可预测住院 COVID-19 患者无创呼吸支持失败。
