Respiratory failure & ventilation
ROX index performance to predict high-flow nasal oxygen outcome in Covid-19 related hypoxemic acute respiratory failure
Authors' conclusion
ROX index cut-off values seem population-specific and the ROX index appears to have a technically acceptable but clinically low capability to discriminate between HFNO failures and successes in Covid-19 ARF patients.
Study context
- Population
- Patients with Covid-19 acute respiratory failure first treated with high-flow nasal oxygenation (HFNO)218 screened
- Participants
- 99 patients
- Comparison
- ROX index at H0 vs ROX index at H12, cut-off 4.88 vs ROX index at H12, cut-off 8.73
- Outcome
- Accuracy of ROX index to discriminate HFNO failure (intubation or death; sensitivity) from HFNO success (specificity)
Methodological detailsmulticentre, retrospective cohort, consecutive patients
- Multicentre
- Retrospective cohort
- Consecutive patients
Performance
As reported in the abstract
Discrimination of HFNO failure vs success
| Strategy | Sensitivity | Specificity |
|---|---|---|
| ROX index at H0 | 63% (95%CI 48-77%)Sensitivity on a scale from 0 to 100 percent | 76% (95%CI 62-87%)Specificity on a scale from 0 to 100 percent |
| ROX index at H12, cut-off 4.88 | 29% (95%CI 14-48%)Sensitivity on a scale from 0 to 100 percent | 90% (95%CI 78-97%)Specificity on a scale from 0 to 100 percent |
| ROX index at H12, cut-off 8.73 | 87% (95%CI 70-96%)Sensitivity on a scale from 0 to 100 percent | 45% (95%CI 31-60%)Specificity on a scale from 0 to 100 percent |
Sensitivity
ROX index at H063% (95%CI 48-77%)
ROX index at H12, cut-off 4.8829% (95%CI 14-48%)
ROX index at H12, cut-off 8.7387% (95%CI 70-96%)
Sensitivity on a scale from 0 to 100 percentSpecificity
ROX index at H076% (95%CI 62-87%)
ROX index at H12, cut-off 4.8890% (95%CI 78-97%)
ROX index at H12, cut-off 8.7345% (95%CI 31-60%)
Specificity on a scale from 0 to 100 percentFurther findings
Predictors of HFNO failure (logistic regression)
- ROX index at H0 associated with HFNO failure, univariate analysis
- P = 0.0005
- SAPS II predictive of HFNO failure, multivariate analysis
- P = 0.0003
- Radiographic extension of pulmonary injuries predictive of HFNO failure, multivariate analysis
- P = 0.0263
- ROX index not retained as predictor in multivariate analysis
Original publication
ROX index performance to predict high-flow nasal oxygen outcome in Covid-19 related hypoxemic acute respiratory failure. Ann Intensive Care. Published 18 January 2024. doi:10.
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