ROX index and SpO2/FiO2 ratio for predicting high-flow nasal cannula failure in hypoxemic COVID-19 patients: A multicenter retrospective study
<h4>Background</h4> The ratio of oxygen saturation (ROX) index, defined as the ratio of oxygen saturation (SpO2)/fraction of inspired oxygen (FiO2) to respiratory rate, can help identify patients with hypoxemic respiratory failure at high risk for intubation following high-flow nasal can...
| Main Authors: | , , , , , , , |
|---|---|
| Format: | Article |
| Language: | English |
| Published: |
Public Library of Science (PLoS)
2022-01-01
|
| Series: | PLoS ONE |
| Online Access: | https://www.ncbi.nlm.nih.gov/pmc/articles/PMC9098056/?tool=EBI |
| _version_ | 1811233828579049472 |
|---|---|
| author | Jin Hyoung Kim Ae-Rin Baek Song-I Lee Won-Young Kim Yong Sub Na Bo Young Lee Gil Myeong Seong Moon Seong Baek |
| author_facet | Jin Hyoung Kim Ae-Rin Baek Song-I Lee Won-Young Kim Yong Sub Na Bo Young Lee Gil Myeong Seong Moon Seong Baek |
| author_sort | Jin Hyoung Kim |
| collection | DOAJ |
| description | <h4>Background</h4> The ratio of oxygen saturation (ROX) index, defined as the ratio of oxygen saturation (SpO2)/fraction of inspired oxygen (FiO2) to respiratory rate, can help identify patients with hypoxemic respiratory failure at high risk for intubation following high-flow nasal cannula (HFNC) initiation; however, whether it is effective for predicting intubation in coronavirus disease 2019 (COVID-19) patients receiving HFNC remains unknown. Moreover, the SpO2/FiO2 ratio has been assessed as a prognostic marker for acute hypoxemic respiratory failure. This study aimed to determine the utility of the ROX index and the SpO2/FiO2 ratio as predictors of failure in COVID-19 patients who received HFNC. <h4>Methods</h4> This multicenter study was conducted in seven university-affiliated hospitals in Korea. Data of consecutive hospitalized patients diagnosed with COVID-19 between February 10, 2020 and February 28, 2021 were retrospectively reviewed. We calculated the ROX index and the SpO2/FiO2 ratio at 1 h, 4 h, and 12 h after HFNC initiation. The primary outcome was HFNC failure defined as the need for subsequent intubation despite HFNC application. The receiver operating characteristic curve analysis was used to evaluate discrimination of prediction models for HFNC failure. <h4>Results</h4> Of 1,565 hospitalized COVID-19 patients, 133 who received HFNC were analyzed. Among them, 63 patients (47.4%) were successfully weaned from HFNC, and 70 (52.6%) were intubated. Among patients with HFNC failure, 32 (45.7%) died. The SpO2/FiO2 ratio at 1 h after HFNC initiation was an important predictor of HFNC failure (AUC 0.762 [0.679–0.846]). The AUCs of SpO2/FiO2 ratio at 4 h and ROX indices at 1 h and 4 h were 0.733 (0.640–0.826), 0.697 (0.597–0.798), and 0.682 (0.583–0.781), respectively. Multivariable analysis showed that the patients aged ≥70 years are 3.4 times more likely to experience HFNC failure than those aged <70 years (HR 3.367 [1.358–8.349], p = 0.009). The SpO2/FiO2 ratio (HR 0.983 [0.972–0.994], p = 0.003) at 1 h was significantly associated with HFNC failure. <h4>Conclusions</h4> The SpO2/FiO2 ratio following HFNC initiation was an acceptable predictor of HFNC failure. The SpO2/FiO2 ratio may be a good prognostic marker for predicting intubation in COVID-9 patients receiving HFNC. |
| first_indexed | 2024-04-12T11:25:52Z |
| format | Article |
| id | doaj.art-dc9cf1d22ea349bc908b71f4f5b86ae5 |
| institution | Directory Open Access Journal |
| issn | 1932-6203 |
| language | English |
| last_indexed | 2024-04-12T11:25:52Z |
| publishDate | 2022-01-01 |
| publisher | Public Library of Science (PLoS) |
| record_format | Article |
| series | PLoS ONE |
| spelling | doaj.art-dc9cf1d22ea349bc908b71f4f5b86ae52022-12-22T03:35:13ZengPublic Library of Science (PLoS)PLoS ONE1932-62032022-01-01175ROX index and SpO2/FiO2 ratio for predicting high-flow nasal cannula failure in hypoxemic COVID-19 patients: A multicenter retrospective studyJin Hyoung KimAe-Rin BaekSong-I LeeWon-Young KimYong Sub NaBo Young LeeGil Myeong SeongMoon Seong Baek<h4>Background</h4> The ratio of oxygen saturation (ROX) index, defined as the ratio of oxygen saturation (SpO2)/fraction of inspired oxygen (FiO2) to respiratory rate, can help identify patients with hypoxemic respiratory failure at high risk for intubation following high-flow nasal cannula (HFNC) initiation; however, whether it is effective for predicting intubation in coronavirus disease 2019 (COVID-19) patients receiving HFNC remains unknown. Moreover, the SpO2/FiO2 ratio has been assessed as a prognostic marker for acute hypoxemic respiratory failure. This study aimed to determine the utility of the ROX index and the SpO2/FiO2 ratio as predictors of failure in COVID-19 patients who received HFNC. <h4>Methods</h4> This multicenter study was conducted in seven university-affiliated hospitals in Korea. Data of consecutive hospitalized patients diagnosed with COVID-19 between February 10, 2020 and February 28, 2021 were retrospectively reviewed. We calculated the ROX index and the SpO2/FiO2 ratio at 1 h, 4 h, and 12 h after HFNC initiation. The primary outcome was HFNC failure defined as the need for subsequent intubation despite HFNC application. The receiver operating characteristic curve analysis was used to evaluate discrimination of prediction models for HFNC failure. <h4>Results</h4> Of 1,565 hospitalized COVID-19 patients, 133 who received HFNC were analyzed. Among them, 63 patients (47.4%) were successfully weaned from HFNC, and 70 (52.6%) were intubated. Among patients with HFNC failure, 32 (45.7%) died. The SpO2/FiO2 ratio at 1 h after HFNC initiation was an important predictor of HFNC failure (AUC 0.762 [0.679–0.846]). The AUCs of SpO2/FiO2 ratio at 4 h and ROX indices at 1 h and 4 h were 0.733 (0.640–0.826), 0.697 (0.597–0.798), and 0.682 (0.583–0.781), respectively. Multivariable analysis showed that the patients aged ≥70 years are 3.4 times more likely to experience HFNC failure than those aged <70 years (HR 3.367 [1.358–8.349], p = 0.009). The SpO2/FiO2 ratio (HR 0.983 [0.972–0.994], p = 0.003) at 1 h was significantly associated with HFNC failure. <h4>Conclusions</h4> The SpO2/FiO2 ratio following HFNC initiation was an acceptable predictor of HFNC failure. The SpO2/FiO2 ratio may be a good prognostic marker for predicting intubation in COVID-9 patients receiving HFNC.https://www.ncbi.nlm.nih.gov/pmc/articles/PMC9098056/?tool=EBI |
| spellingShingle | Jin Hyoung Kim Ae-Rin Baek Song-I Lee Won-Young Kim Yong Sub Na Bo Young Lee Gil Myeong Seong Moon Seong Baek ROX index and SpO2/FiO2 ratio for predicting high-flow nasal cannula failure in hypoxemic COVID-19 patients: A multicenter retrospective study PLoS ONE |
| title | ROX index and SpO2/FiO2 ratio for predicting high-flow nasal cannula failure in hypoxemic COVID-19 patients: A multicenter retrospective study |
| title_full | ROX index and SpO2/FiO2 ratio for predicting high-flow nasal cannula failure in hypoxemic COVID-19 patients: A multicenter retrospective study |
| title_fullStr | ROX index and SpO2/FiO2 ratio for predicting high-flow nasal cannula failure in hypoxemic COVID-19 patients: A multicenter retrospective study |
| title_full_unstemmed | ROX index and SpO2/FiO2 ratio for predicting high-flow nasal cannula failure in hypoxemic COVID-19 patients: A multicenter retrospective study |
| title_short | ROX index and SpO2/FiO2 ratio for predicting high-flow nasal cannula failure in hypoxemic COVID-19 patients: A multicenter retrospective study |
| title_sort | rox index and spo2 fio2 ratio for predicting high flow nasal cannula failure in hypoxemic covid 19 patients a multicenter retrospective study |
| url | https://www.ncbi.nlm.nih.gov/pmc/articles/PMC9098056/?tool=EBI |
| work_keys_str_mv | AT jinhyoungkim roxindexandspo2fio2ratioforpredictinghighflownasalcannulafailureinhypoxemiccovid19patientsamulticenterretrospectivestudy AT aerinbaek roxindexandspo2fio2ratioforpredictinghighflownasalcannulafailureinhypoxemiccovid19patientsamulticenterretrospectivestudy AT songilee roxindexandspo2fio2ratioforpredictinghighflownasalcannulafailureinhypoxemiccovid19patientsamulticenterretrospectivestudy AT wonyoungkim roxindexandspo2fio2ratioforpredictinghighflownasalcannulafailureinhypoxemiccovid19patientsamulticenterretrospectivestudy AT yongsubna roxindexandspo2fio2ratioforpredictinghighflownasalcannulafailureinhypoxemiccovid19patientsamulticenterretrospectivestudy AT boyounglee roxindexandspo2fio2ratioforpredictinghighflownasalcannulafailureinhypoxemiccovid19patientsamulticenterretrospectivestudy AT gilmyeongseong roxindexandspo2fio2ratioforpredictinghighflownasalcannulafailureinhypoxemiccovid19patientsamulticenterretrospectivestudy AT moonseongbaek roxindexandspo2fio2ratioforpredictinghighflownasalcannulafailureinhypoxemiccovid19patientsamulticenterretrospectivestudy |