The Predictive Values of Respiratory Rate Oxygenation Index and Chest Computed Tomography Severity Score for High-Flow Nasal Oxygen Failure in Critically Ill Patients with Coronavirus Disease-2019
Background: The prediction of high-flow nasal oxygen (HFNO) failure in patients with coronavirus disease-2019 (COVID-19) having acute respiratory failure (ARF) may prevent delayed intubation and decrease mortality. Aims: To define the related risk factors to HFNO failure and hospital mortality Stu...
| Main Authors: | , , , , , , , , , , |
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| Format: | Article |
| Language: | English |
| Published: |
Galenos Publishing House
2022-03-01
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| Series: | Balkan Medical Journal |
| Online Access: | https://balkanmedicaljournal.org/text.php?lang=en&id=2378 |
| _version_ | 1828028853344272384 |
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| author | Murat Küçük Begüm Ergan Mehmet Nuri Yakar Bişar Ergün Yunus Akdoğan Ali Cantürk Naciye Sinem Gezer Fahreddin Kalkan Erdem Yaka Bilgin Cömert Necati Ali Gökmen |
| author_facet | Murat Küçük Begüm Ergan Mehmet Nuri Yakar Bişar Ergün Yunus Akdoğan Ali Cantürk Naciye Sinem Gezer Fahreddin Kalkan Erdem Yaka Bilgin Cömert Necati Ali Gökmen |
| author_sort | Murat Küçük |
| collection | DOAJ |
| description | Background: The prediction of high-flow nasal oxygen (HFNO) failure in patients with coronavirus disease-2019 (COVID-19) having acute respiratory failure (ARF) may prevent delayed intubation and decrease mortality.
Aims: To define the related risk factors to HFNO failure and hospital mortality
Study Design: Retrospective cohort study.
Methods: To this study, 85 critically ill patients (≥18 years) with COVID-19 related acute kidney injury who were treated with HFNO were enrolled. Treatment success was defined as the de-escalation of the oxygenation support to the conventional oxygen therapies. HFNO therapy failure was determined as the need for invasive mechanical ventilation or death. The patients were divided into HFNO-failure (HFNO-F) and HFNO-success (HFNO-S) groups. Electronic medical records and laboratory data were screened for all patients. Respiratory rate oxygenation (ROX) index on the first hour and chest computed tomography (CT) severity score were calculated. Factors related to HFNO therapy failure and mortality were defined.
Results: This study assessed 85 patients (median age 67 years, 69.4% male) who were divided into two groups as HFNO success (n = 33) and HFNO failure (n = 52). The respiratory rate oxygenation (ROX) was measured at 1 hour and the computed tomography (CT) score indicated HFNO failure and intubation, with an area under the receiver operating characteristic of 0.695 for the ROX index and 0.628 for the CT score. A ROX index of <3.81 and a CT score of >15 in the first hour of therapy were the predictors of HFNO failure and intubation. Age, Acute Physiology and Chronic Health Evaluation II score, arterial blood gas findings “(i.e., partial pressure of oxygen [PaO2], PaO2 [fraction of inspired oxygen]/SO2 [oxygen saturation] ratio)”, and D-dimer levels were also associated with HFNO failure; however, based on logistic regression analysis, a calculated ROX on the first hour of therapy of <3.81 (odds ratio [OR] = 4.78, 95% confidence interval [CI] = 1.75–13.02, P = 0.001) and a chest CT score of >15 (OR = 2.83, 95% CI = 1.01–7.88, P = <0.001) were the only independent risk factors. In logistic regression analysis, a ROX calculated on the first hour of therapy of <3.81 (OR = 4.78, [95% CI = 1.75–13.02], P = 0.001) and a chest CT score of >15 (OR 2.83, 95% CI = 1.01–7.88, P = <0.001) were the independent risk factors for the HFNO failure. The intensive care unit and hospital mortality rates were 80.2% and 82.7%, respectively, in the HFNO failure group.
Conclusion: The early prediction of HFNO therapy failure is essential considering the high mortality rate in patients with HFNO therapy failure. Using the ROX index and the chest CT severity score combined with the other clinical parameters may reduce mortality. Additionally, multi-centre observational studies are needed to define the predictive value of ROX and chest CT score not only for COVID-19 but also other causes of ARF. |
| first_indexed | 2024-04-10T13:59:54Z |
| format | Article |
| id | doaj.art-4b558472254e4ac7ba0d575797959740 |
| institution | Directory Open Access Journal |
| issn | 2146-3123 2146-3131 |
| language | English |
| last_indexed | 2024-04-10T13:59:54Z |
| publishDate | 2022-03-01 |
| publisher | Galenos Publishing House |
| record_format | Article |
| series | Balkan Medical Journal |
| spelling | doaj.art-4b558472254e4ac7ba0d5757979597402023-02-15T16:10:17ZengGalenos Publishing HouseBalkan Medical Journal2146-31232146-31312022-03-0139214014710.4274/balkanmedj.galenos.2021.2021-7-32 The Predictive Values of Respiratory Rate Oxygenation Index and Chest Computed Tomography Severity Score for High-Flow Nasal Oxygen Failure in Critically Ill Patients with Coronavirus Disease-2019Murat Küçük0https://orcid.org/0000-0003-1705-645XBegüm Ergan1https://orcid.org/0000-0003-2920-9214Mehmet Nuri Yakar2https://orcid.org/0000-0002-3542-3906Bişar Ergün3https://orcid.org/0000-0003-4828-7576Yunus Akdoğan4https://orcid.org/0000-0003-3520-7493Ali Cantürk5https://orcid.org/0000-0001-6145-7029Naciye Sinem Gezer6https://orcid.org/0000-0002-0868-4545Fahreddin Kalkan7https://orcid.org/0000-0002-1175-5359Erdem Yaka8https://orcid.org/0000-0002-6644-4240Bilgin Cömert9https://orcid.org/0000-0002-2148-5356Necati Ali Gökmen10https://orcid.org/0000-0002-3225-7666Department of Internal Medicine, Division of Intensive Care, Faculty of Medicine, Dokuz Eylül University, İzmir, TurkeyDepartment of Pulmonary and Critical Care, Faculty of Medicine, Dokuz Eylül University, İzmir, TurkeyDepartment of Anaesthesiology and Reanimation, Division of Intensive Care and Faculty of Medicine, Dokuz Eylül University, İzmir, TurkeyDepartment of Internal Medicine, Division of Intensive Care, Faculty of Medicine, Dokuz Eylül University, İzmir, TurkeyDepartment of Statistics, Faculty of Science, Selçuk University, Konya, TurkeyDepartment of Radiology, Faculty of Medicine, Dokuz Eylül University, İzmir, TurkeyDepartment of Radiology, Faculty of Medicine, Dokuz Eylül University, İzmir, TurkeyDepartment of Actuarial Sciences, Faculty of Science, Selçuk University, Konya, TurkeyDepartment of Neurology, Faculty of Medicine, Dokuz Eylül University, İzmir, TurkeyDepartment of Internal Medicine, Faculty of Medicine, Dokuz Eylül University, İzmir, TurkeyDepartment of Anaesthesiology and Reanimation, Division of Intensive Care and Faculty of Medicine, Dokuz Eylül University, İzmir, TurkeyBackground: The prediction of high-flow nasal oxygen (HFNO) failure in patients with coronavirus disease-2019 (COVID-19) having acute respiratory failure (ARF) may prevent delayed intubation and decrease mortality. Aims: To define the related risk factors to HFNO failure and hospital mortality Study Design: Retrospective cohort study. Methods: To this study, 85 critically ill patients (≥18 years) with COVID-19 related acute kidney injury who were treated with HFNO were enrolled. Treatment success was defined as the de-escalation of the oxygenation support to the conventional oxygen therapies. HFNO therapy failure was determined as the need for invasive mechanical ventilation or death. The patients were divided into HFNO-failure (HFNO-F) and HFNO-success (HFNO-S) groups. Electronic medical records and laboratory data were screened for all patients. Respiratory rate oxygenation (ROX) index on the first hour and chest computed tomography (CT) severity score were calculated. Factors related to HFNO therapy failure and mortality were defined. Results: This study assessed 85 patients (median age 67 years, 69.4% male) who were divided into two groups as HFNO success (n = 33) and HFNO failure (n = 52). The respiratory rate oxygenation (ROX) was measured at 1 hour and the computed tomography (CT) score indicated HFNO failure and intubation, with an area under the receiver operating characteristic of 0.695 for the ROX index and 0.628 for the CT score. A ROX index of <3.81 and a CT score of >15 in the first hour of therapy were the predictors of HFNO failure and intubation. Age, Acute Physiology and Chronic Health Evaluation II score, arterial blood gas findings “(i.e., partial pressure of oxygen [PaO2], PaO2 [fraction of inspired oxygen]/SO2 [oxygen saturation] ratio)”, and D-dimer levels were also associated with HFNO failure; however, based on logistic regression analysis, a calculated ROX on the first hour of therapy of <3.81 (odds ratio [OR] = 4.78, 95% confidence interval [CI] = 1.75–13.02, P = 0.001) and a chest CT score of >15 (OR = 2.83, 95% CI = 1.01–7.88, P = <0.001) were the only independent risk factors. In logistic regression analysis, a ROX calculated on the first hour of therapy of <3.81 (OR = 4.78, [95% CI = 1.75–13.02], P = 0.001) and a chest CT score of >15 (OR 2.83, 95% CI = 1.01–7.88, P = <0.001) were the independent risk factors for the HFNO failure. The intensive care unit and hospital mortality rates were 80.2% and 82.7%, respectively, in the HFNO failure group. Conclusion: The early prediction of HFNO therapy failure is essential considering the high mortality rate in patients with HFNO therapy failure. Using the ROX index and the chest CT severity score combined with the other clinical parameters may reduce mortality. Additionally, multi-centre observational studies are needed to define the predictive value of ROX and chest CT score not only for COVID-19 but also other causes of ARF.https://balkanmedicaljournal.org/text.php?lang=en&id=2378 |
| spellingShingle | Murat Küçük Begüm Ergan Mehmet Nuri Yakar Bişar Ergün Yunus Akdoğan Ali Cantürk Naciye Sinem Gezer Fahreddin Kalkan Erdem Yaka Bilgin Cömert Necati Ali Gökmen The Predictive Values of Respiratory Rate Oxygenation Index and Chest Computed Tomography Severity Score for High-Flow Nasal Oxygen Failure in Critically Ill Patients with Coronavirus Disease-2019 Balkan Medical Journal |
| title | The Predictive Values of Respiratory Rate Oxygenation Index and Chest Computed Tomography Severity Score for High-Flow Nasal Oxygen Failure in Critically Ill Patients with Coronavirus Disease-2019 |
| title_full | The Predictive Values of Respiratory Rate Oxygenation Index and Chest Computed Tomography Severity Score for High-Flow Nasal Oxygen Failure in Critically Ill Patients with Coronavirus Disease-2019 |
| title_fullStr | The Predictive Values of Respiratory Rate Oxygenation Index and Chest Computed Tomography Severity Score for High-Flow Nasal Oxygen Failure in Critically Ill Patients with Coronavirus Disease-2019 |
| title_full_unstemmed | The Predictive Values of Respiratory Rate Oxygenation Index and Chest Computed Tomography Severity Score for High-Flow Nasal Oxygen Failure in Critically Ill Patients with Coronavirus Disease-2019 |
| title_short | The Predictive Values of Respiratory Rate Oxygenation Index and Chest Computed Tomography Severity Score for High-Flow Nasal Oxygen Failure in Critically Ill Patients with Coronavirus Disease-2019 |
| title_sort | predictive values of respiratory rate oxygenation index and chest computed tomography severity score for high flow nasal oxygen failure in critically ill patients with coronavirus disease 2019 |
| url | https://balkanmedicaljournal.org/text.php?lang=en&id=2378 |
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