Souza Isabelle de Almeida, Shalova Asiya, Vieira Nayane Maria, Barros João Carlos Clark, Ferreira Gustavo Martins, Azevedo Paula Schmidt, Polegato Bertha Furlan, Zornoff Leonardo Antônio Mamede, Paiva Sérgio Alberto Rupp de, Lazzarin Taline, Minicucci Marcos Ferreira
Department of Internal Medicine, Botucatu Medical School, UNESP - Univ Estadual Paulista, Botucatu, Brazil.
Department of Internal Medicine, Botucatu Medical School, UNESP - Univ Estadual Paulista, Botucatu, Brazil.
Aust Crit Care. 2025 May;38(3):101222. doi: 10.1016/j.aucc.2025.101222. Epub 2025 Mar 28.
This study evaluates the association between the respiratory rate-oxygenation (ROX) index and the National Early Warning Score 2 (NEWS2) score with orotracheal intubation (OTI) and in-hospital mortality in patients with cardiogenic pulmonary oedema (CPE).
This retrospective observational study enrolled patients aged 18 years or older who had developed CPE at admission or during hospital stay. Demographic, clinical, and laboratory data were collected within the first 24 h of CPE onset from the electronic records. The outcomes needed for OTI during 24 h after CPE diagnosis and in-hospital mortality were also collected. The ROX index and NEWS2 were calculated using variables collected at CPE occurrence.
Two hundred eighty-six patients with CPE were evaluated; however, 68 patients were excluded due to the absence of variables to calculate the ROX index. Thus, we included 218 patients in the analysis. The mean age was 67.8 ± 14.0 years, 51.8% were female, the median of the ROX index was 9.29 (6.06-13.05), and the median of the NEWS2 was 10.0 (7.0-12.0). Amongst these patients, 28.0% needed OTI 24 h after CPE and 30.3% died. In univariate analysis, lower values of the ROX index and higher values of the NEWS2 were associated with OTI. There was no association with mortality. In logistic regression models, the ROX index and NEWS2 were associated with OTI when adjusted by smoking, time of CPE, and endovenous nitrate and morphine (ROX index: odds ratio [OR] = 0.908, 95% confidence interval [CI] = 0.843-0.979, p = 0.012; NEWS2: OR = 1.261, 95% CI = 1.049-1.514, p = 0.013) and when adjusted by age, sex, and time of CPE (at admission or during hospital stay; ROX index: OR = 0.909, 95% CI = 0.847-0.976, p = 0.008; NEWS2: OR = 1.190, 95% CI = 1.015-1.396, p = 0.032).
The ROX index and NEWS2 were associated with OTI in CPE despite no association with mortality.
本研究评估呼吸频率-氧合（ROX）指数与国家早期预警评分2（NEWS2）评分与心源性肺水肿（CPE）患者经口气管插管（OTI）及院内死亡率之间的关联。
这项回顾性观察性研究纳入了入院时或住院期间发生CPE的18岁及以上患者。从电子记录中收集CPE发病后最初24小时内的人口统计学、临床和实验室数据。还收集了CPE诊断后24小时内OTI所需的结果及院内死亡率。使用CPE发生时收集的变量计算ROX指数和NEWS2。
对286例CPE患者进行了评估；然而，68例患者因缺乏计算ROX指数的变量而被排除。因此，我们将218例患者纳入分析。平均年龄为67.8±14.0岁，51.8%为女性，ROX指数中位数为9.29（6.06 - 13.05），NEWS2中位数为10.0（7.0 - 12.0）。在这些患者中，28.0%在CPE后24小时需要OTI，30.3%死亡。在单因素分析中，ROX指数较低值和NEWS2较高值与OTI相关。与死亡率无关。在逻辑回归模型中，调整吸烟、CPE时间、静脉注射硝酸盐和吗啡后，ROX指数和NEWS2与OTI相关（ROX指数：比值比[OR]=0.908，95%置信区间[CI]=0.843 - 0.979，p = 0.012；NEWS2：OR = 1.261，95% CI = 1.049 - 1.514，p = 0.013），调整年龄、性别和CPE时间（入院时或住院期间）后也相关（ROX指数：OR = 0.909，95% CI = 0.847 - 0.976，p = 0.008；NEWS2：OR = 1.190，95% CI = 1.015 - 1.396，p = 0.032）。
ROX指数和NEWS2与CPE患者的OTI有关，但与死亡率无关。
