Respiratory failure & ventilation
External validation of the HACOR score and ROX index for predicting treatment failure in patients with coronavirus disease 2019 pneumonia managed on high-flow nasal cannula therapy: a multicenter retrospective observational study in Japan
Authors' conclusion
In COVID-19 patients receiving HFNC therapy in Japan, the predictive performance of the HACOR score and ROX index at the 2-h time-point may be inadequate.
Study context
- Population
- Adults (≥ 18 years) with COVID-19 treated with high-flow nasal cannula (HFNC) therapy in Japan, January 16, 2020 to March 31, 2022
- Participants
- 300 adults · 9 institutions
- Comparison
- HACOR score vs ROX index for predicting HFNC treatment failure
- Outcome
- Treatment failure (intubation or death within 7 days); AUROC at the 2-h time-point
- Follow-up
- 2 h
Methodological detailsexternal validation, retrospective, observational, multicentre
- External validation
- Retrospective
- Observational
- Multicentre
Performance
As reported in the abstract
Treatment failure, AUROC
| Test or model | AUROC | Sensitivity (HACOR score > 5) | Sensitivity (ROX index < 2.85) | Specificity (HACOR score > 5) | Specificity (ROX index < 2.85) |
|---|---|---|---|---|---|
| HACOR score | 0.63 | 18% | — not stated in the abstract | 91% | — not stated in the abstract |
| ROX index | 0.57 | — not stated in the abstract | 3% | — not stated in the abstract | 100% |
AUROC
HACOR score0.63
ROX index0.57
Sensitivity (HACOR score > 5)
HACOR score18%
ROX index— not stated in the abstract
Sensitivity (ROX index < 2.85)
HACOR score— not stated in the abstract
ROX index3%
Specificity (HACOR score > 5)
HACOR score91%
ROX index— not stated in the abstract
Specificity (ROX index < 2.85)
HACOR score— not stated in the abstract
ROX index100%
— not stated in the abstract
- HACOR score vs ROX index: P = 0.24
- Treatment failure within 7 days
- 127 (42%)
Further findings
| Outcome | HACOR score | ROX index |
|---|---|---|
| AUROC at other time-points · 6, 12, 24, 48 h | ||
| AUROC 6 h | 0.58 | 0.62 |
| AUROC 12 h | 0.70 | 0.68 |
| AUROC 24 h | 0.68 | 0.69 |
| AUROC 48 h | 0.75 | 0.75 |
Calibration (visual assessment)
- HACOR score well calibrated, ROX index not
Original publication
External validation of the HACOR score and ROX index for predicting treatment failure in patients with coronavirus disease 2019 pneumonia managed on high-flow nasal cannula therapy: a multicenter retrospective observational study in Japan. J Intensive Care. Published 15 February 2024. doi:10.
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