Predictors of Noninvasive Respiratory Support Failure in COVID-19 Patients: A Prospective Observational Study
<i>Background and Objective:</i> Respiratory assistance tactic that is best for COVID-19-associated acute hypoxemic respiratory failure (AHRF) individuals has yet to be determined. Patients with AHRF may benefit from the use of a high-flow nasal cannula (HFNC) and non-invasive ventilatio...
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| Format: | Article |
| Language: | English |
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MDPI AG
2022-06-01
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| Series: | Medicina |
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| Online Access: | https://www.mdpi.com/1648-9144/58/6/769 |
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| author | Rolandas Zablockis Goda Šlekytė Rūta Mereškevičienė Karolina Kėvelaitienė Birutė Zablockienė Edvardas Danila |
| author_facet | Rolandas Zablockis Goda Šlekytė Rūta Mereškevičienė Karolina Kėvelaitienė Birutė Zablockienė Edvardas Danila |
| author_sort | Rolandas Zablockis |
| collection | DOAJ |
| description | <i>Background and Objective:</i> Respiratory assistance tactic that is best for COVID-19-associated acute hypoxemic respiratory failure (AHRF) individuals has yet to be determined. Patients with AHRF may benefit from the use of a high-flow nasal cannula (HFNC) and non-invasive ventilation (NIV). The goals of this prospective observational research were to estimate predictive factors for HFNC and NIV failure in COVID-19-related AHRF subjects. <i>Materials and Methods:</i> The research enlisted the participation of 124 patients. A stepwise treatment approach was used. HFNC and NIV were used on 124 (100%) and 64 (51.6%) patients, respectively. Thirty (24.2%) of 124 patients were intubated and received invasive mechanical ventilation. <i>Results:</i> 85 (68.5%) patients were managed successfully. Patients who required NIV exhibited a higher prevalence of treatment failure (70.3% vs. 51.6%, <i>p</i> = 0.019) and had higher mortality (59.4% vs. 31.5%, <i>p</i> = 0.001) than patients who received HFNC. Using logistic regression, the respiratory rate oxygenation (ROX) index at 24 h (odds ratio (OR) = 0.74, <i>p</i> = 0.018) and the Charlson Comorbidity Index (CCI) (OR = 1.60, <i>p</i> = 0.003) were found to be predictors of HFNC efficacy. It was the ROX index at 24 h and the CCI optimum cut-off values for HFNC outcome that were 6.1 (area under the curve (AUC) = 0.73) and 2.5 (AUC = 0.68), respectively. Serum ferritin level (OR = 0.23, <i>p</i> = 0.041) and lymphocyte count (OR = 1.03, <i>p</i> = 0.01) were confirmed as predictors of NIV failure. Serum ferritin level at a cut-off value of 456.2 ng/mL (AUC = 0.67) and lymphocyte count lower than 0.70 per mm<sup>3</sup>, (AUC = 0.70) were associated with NIV failure with 70.5% sensitivity, 68.7% specificity and sensitivity of 84.1%, specificity of 56.2%, respectively. <i>Conclusion:</i> The ROX index at 24 h, CCI, as well as serum ferritin level, and lymphocyte count can be used as markers for HFNC and NIV failure, respectively, in SARS-CoV-2-induced AHRF patients. |
| first_indexed | 2024-03-09T23:07:24Z |
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| id | doaj.art-f52e4a0eea074969af72e84cb19be09d |
| institution | Directory Open Access Journal |
| issn | 1010-660X 1648-9144 |
| language | English |
| last_indexed | 2024-03-09T23:07:24Z |
| publishDate | 2022-06-01 |
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| series | Medicina |
| spelling | doaj.art-f52e4a0eea074969af72e84cb19be09d2023-11-23T17:52:17ZengMDPI AGMedicina1010-660X1648-91442022-06-0158676910.3390/medicina58060769Predictors of Noninvasive Respiratory Support Failure in COVID-19 Patients: A Prospective Observational StudyRolandas Zablockis0Goda Šlekytė1Rūta Mereškevičienė2Karolina Kėvelaitienė3Birutė Zablockienė4Edvardas Danila5Clinic of Chest Diseases, Immunology and Allergology, Institute of Clinical Medicine, Vilnius University, M.K. Ciurlionio 21, 03101 Vilnius, LithuaniaClinic of Chest Diseases, Immunology and Allergology, Institute of Clinical Medicine, Vilnius University, M.K. Ciurlionio 21, 03101 Vilnius, LithuaniaCentre of Pulmonology and Allergology, Vilnius University Hospital Santaros Klinikos, Santariskiu St. 2, 08661 Vilnius, LithuaniaClinic of Chest Diseases, Immunology and Allergology, Institute of Clinical Medicine, Vilnius University, M.K. Ciurlionio 21, 03101 Vilnius, LithuaniaClinic of Infectious Diseases and Dermatovenerology, Institute of Clinical Medicine, Vilnius University, M.K. Ciurlionio 21, 03101 Vilnius, LithuaniaClinic of Chest Diseases, Immunology and Allergology, Institute of Clinical Medicine, Vilnius University, M.K. Ciurlionio 21, 03101 Vilnius, Lithuania<i>Background and Objective:</i> Respiratory assistance tactic that is best for COVID-19-associated acute hypoxemic respiratory failure (AHRF) individuals has yet to be determined. Patients with AHRF may benefit from the use of a high-flow nasal cannula (HFNC) and non-invasive ventilation (NIV). The goals of this prospective observational research were to estimate predictive factors for HFNC and NIV failure in COVID-19-related AHRF subjects. <i>Materials and Methods:</i> The research enlisted the participation of 124 patients. A stepwise treatment approach was used. HFNC and NIV were used on 124 (100%) and 64 (51.6%) patients, respectively. Thirty (24.2%) of 124 patients were intubated and received invasive mechanical ventilation. <i>Results:</i> 85 (68.5%) patients were managed successfully. Patients who required NIV exhibited a higher prevalence of treatment failure (70.3% vs. 51.6%, <i>p</i> = 0.019) and had higher mortality (59.4% vs. 31.5%, <i>p</i> = 0.001) than patients who received HFNC. Using logistic regression, the respiratory rate oxygenation (ROX) index at 24 h (odds ratio (OR) = 0.74, <i>p</i> = 0.018) and the Charlson Comorbidity Index (CCI) (OR = 1.60, <i>p</i> = 0.003) were found to be predictors of HFNC efficacy. It was the ROX index at 24 h and the CCI optimum cut-off values for HFNC outcome that were 6.1 (area under the curve (AUC) = 0.73) and 2.5 (AUC = 0.68), respectively. Serum ferritin level (OR = 0.23, <i>p</i> = 0.041) and lymphocyte count (OR = 1.03, <i>p</i> = 0.01) were confirmed as predictors of NIV failure. Serum ferritin level at a cut-off value of 456.2 ng/mL (AUC = 0.67) and lymphocyte count lower than 0.70 per mm<sup>3</sup>, (AUC = 0.70) were associated with NIV failure with 70.5% sensitivity, 68.7% specificity and sensitivity of 84.1%, specificity of 56.2%, respectively. <i>Conclusion:</i> The ROX index at 24 h, CCI, as well as serum ferritin level, and lymphocyte count can be used as markers for HFNC and NIV failure, respectively, in SARS-CoV-2-induced AHRF patients.https://www.mdpi.com/1648-9144/58/6/769COVID-19acute hypoxemic respiratory failurehigh-flow nasal cannulanon-invasive ventilationpredictive factor |
| spellingShingle | Rolandas Zablockis Goda Šlekytė Rūta Mereškevičienė Karolina Kėvelaitienė Birutė Zablockienė Edvardas Danila Predictors of Noninvasive Respiratory Support Failure in COVID-19 Patients: A Prospective Observational Study Medicina COVID-19 acute hypoxemic respiratory failure high-flow nasal cannula non-invasive ventilation predictive factor |
| title | Predictors of Noninvasive Respiratory Support Failure in COVID-19 Patients: A Prospective Observational Study |
| title_full | Predictors of Noninvasive Respiratory Support Failure in COVID-19 Patients: A Prospective Observational Study |
| title_fullStr | Predictors of Noninvasive Respiratory Support Failure in COVID-19 Patients: A Prospective Observational Study |
| title_full_unstemmed | Predictors of Noninvasive Respiratory Support Failure in COVID-19 Patients: A Prospective Observational Study |
| title_short | Predictors of Noninvasive Respiratory Support Failure in COVID-19 Patients: A Prospective Observational Study |
| title_sort | predictors of noninvasive respiratory support failure in covid 19 patients a prospective observational study |
| topic | COVID-19 acute hypoxemic respiratory failure high-flow nasal cannula non-invasive ventilation predictive factor |
| url | https://www.mdpi.com/1648-9144/58/6/769 |
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