Lijović Lada, Radočaj Tomislav, Kovač Nataša, Vučić Marinko, Elbers Paul
Department of Intensive Care Medicine, Laboratory for Critical Care Computational Intelligence, Amsterdam Medical Data Science, Amsterdam Public Health, Amsterdam Cardiovascular Science, Amsterdam Institute for Infection and Immunity, Amsterdam UMC, University of Amsterdam, Vrije Universiteit, Amsterdam, The Netherlands; Department of Anesthesiology, Intensive Care and Pain Management, Sestre Milosrdnice University Hospital Center, Zagreb, Croatia.
Department of Anesthesiology, Intensive Care and Pain Management, Sestre Milosrdnice University Hospital Center, Zagreb, Croatia.
Med Intensiva (Engl Ed). 2025 Jul;49(7):502136. doi: 10.1016/j.medine.2025.502136. Epub 2025 Jan 13.
To determine whether the ROX index and its variations can predict the risk of intubation in ICU patients receiving NIV ventilation using large public ICU databases.
Retrospective observational cohort study.
Patient data was extracted from both the AmsterdamUMCdb and the MIMIC-IV ICU databases, which contained data related to 20,109 and 50,920 unique patients.
Non-invasively mechanically ventilated.
Retrospective review of variables.
To assess the predictive values of models for each index, the ROX and its variations mROX, ROX-HR and mROX-HR were calculated based on mean values of SpO, respiratory rate, FiO and PaO from 2-h windows within the first 12 h of NIV.
3344 patients were eligible for analysis of which 1344 were intubated, died or returned to NIV within 24 h of ending NIV. NIV failure group had higher SOFA scores and higher CRP levels at admission. There was no difference in duration of NIV therapy or 28-day mortality, but patients who failed NIV had longer length of stay. The best performing index was ROX with an AUROC of 0.626 at 10-12 h. All other indices for all other time windows were less discriminating.
The performance of ROX index and its variations to predict NIV failure in ICU patients across large public ICU databases was moderate at best and cannot currently be recommended for clinical decision support.
利用大型公共重症监护病房（ICU）数据库，确定ROX指数及其变化是否能够预测接受无创通气（NIV）的ICU患者的插管风险。
回顾性观察队列研究。
从阿姆斯特丹大学医学中心数据库（AmsterdamUMCdb）和多中心重症监护医学信息数据库第四版（MIMIC-IV）ICU数据库中提取患者数据，这两个数据库分别包含20109例和50920例不同患者的数据。
接受无创机械通气。
对变量进行回顾性分析。
为评估各指数模型的预测价值，在NIV开始的前12小时内，基于2小时窗口内的血氧饱和度（SpO）、呼吸频率、吸入氧浓度（FiO）和动脉血氧分压（PaO）的平均值计算ROX指数及其变化，即改良ROX指数（mROX）、ROX-心率（ROX-HR）和改良ROX-心率（mROX-HR）。
3344例患者符合分析条件，其中1344例在NIV结束后24小时内进行了插管、死亡或恢复NIV治疗。NIV失败组入院时序贯器官衰竭评估（SOFA）评分和C反应蛋白（CRP）水平更高。NIV治疗持续时间或28天死亡率无差异，但NIV失败的患者住院时间更长。表现最佳的指数是ROX，在10-12小时时受试者工作特征曲线下面积（AUROC）为0.626。所有其他时间窗口的所有其他指数的鉴别能力均较低。
在大型公共ICU数据库中，ROX指数及其变化对预测ICU患者NIV失败的表现充其量只能说是中等，目前不能推荐用于临床决策支持。
