Respiratory failure & ventilation
Performance of the respiratory oxygenation (ROX) index in predicting high flow nasal cannula failure in COVID-19 patients: a systematic review and meta-analysis
Authors' conclusion
Our analysis confirms the overall utility of the ROX index in risk stratification of COVID-19 patients with AHRF receiving HFNC and provides potentially useful cut-offs for different times from HFNC initiation.
Study context
- Population
- COVID-19 patients with acute hypoxemic respiratory failure receiving high flow nasal cannula (HFNC)
- Participants
- 4,790 patients · 24 studies
- Outcome
- Optimal ROX index cut-offs for predicting HFNC failure
Methodological detailsreconstructed confusion matrices, linear mixed models, summary ROC analysis
- Reconstructed confusion matrices
- Linear mixed models
- Summary ROC analysis
Pooled result
As reported in the abstract
Overall prediction of HFNC failure by ROX index
- Overall sAUC
- 0.771 (95% CI: 0.666-0.847)
- Optimal cut-off
- 5.23
- Sensitivity at optimal cut-off
- 0.732
- Specificity at optimal cut-off
- 0.690
- Cut-offs for 80%, 90% sensitivity, 80%, 90% specificity
- 5.70, 6.69, 4.45, 3.37
Further pooled results
Proposed cut-offs by ROX measurement time
- 2-6 h post-HFNC initiation: 80% specific cut-off to rule in HFNC failure
- < 5.33
- 6-12 h post-HFNC initiation: 80% specific cut-off to rule in HFNC failure
- < 3.69
- 12-24 h post-HFNC initiation: 80% sensitive cut-off to rule out HFNC failure
- > 6.07
Original publication
Performance of the ROX index in predicting high flow nasal cannula failure in COVID-19 patients: a systematic review and meta-analysis. Crit Care. Published 21 August 2023. doi:10.
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