https://doi.org/10.4081/monaldi.2024.3033
Respiratory rate-oxygenation index on the 3rd day is the best predictor of treatment failure in COVID-19 patients
Submitted: April 25, 2024
Accepted: September 17, 2024
Published: October 24, 2024
Accepted: September 17, 2024
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SUPPLEMENTARY MATERIAL: 7
SUPPLEMENTARY MATERIAL: 7
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All claims expressed in this article are solely those of the authors and do not necessarily represent those of their affiliated organizations, or those of the publisher, the editors and the reviewers. Any product that may be evaluated in this article or claim that may be made by its manufacturer is not guaranteed or endorsed by the publisher.
Authors
Predictors of outcomes are essential to identifying severe COVID-19 cases and optimizing treatment and care settings. The respiratory rate-oxygenation (ROX) index, originally introduced for predicting the failure of non-invasive support in acute hypoxemic respiratory failure (AHRF), has not been extensively studied over time during hospitalization. This multicenter prospective observational study analyzed COVID-19-related AHRF patients admitted to eight Italian hospitals during the second pandemic wave. The study assessed the ROX index using receiver operator characteristic curves and areas under the curve with 95% confidence intervals to predict treatment failure, defined as endotracheal intubation (ETI) or death. A total of 227 patients (69.2% males) were enrolled, with a median arterial partial pressure of oxygen (PaO2)/fraction of inspired oxygen (FiO2) ratio at admission of 248 (interquartile range: 170-295). Nearly one-third (29.5%) required ETI or died during hospitalization. Those who experienced treatment failure were older (median age 70 versus 61 years, p<0.001), more likely to be current or former smokers (8.5% versus 6.4% and 42.4% versus 25.5%, p=0.039), had a higher prevalence of cardiovascular diseases (74.6% versus 46.3%, p<0.001), and had a lower PaO2/FiO2 ratio at presentation (median 229 versus 254, p=0.014). Gender, body mass index, and other comorbidities showed no significant differences. In patients who failed treatment, the ROX index was higher at presentation and worsened sharply by days 3 and 4. Conversely, in patients who survived without requiring ETI, the ROX index remained stable and reduced after 5-6 days. The ROX index's predictive ability improved notably by the third day of hospitalization, with the best cut-off value identified at 8.53 (sensitivity 75%, specificity 68%). Kaplan-Meier curves indicated that a ROX index of 8.53 or lower on days 1, 2, or 3 was associated with a higher risk of treatment failure. Thus, a single ROX index assessment on day 3 is more informative than its variability over time, with values of 8.53 or lower predicting non-invasive respiratory support failure in hospitalized COVID-19 patients.
The RECOVERY Collaborative Group. Dexamethasone in hospitalized patients with Covid-19. N Engl J Med 2021;384:693-704.
DOI: https://doi.org/10.1056/NEJMoa2021436
Havers FP, Pham H, Taylor CA, et al. COVID-19-associated hospitalizations among vaccinated and unvaccinated adults 18 years or older in 13 US states, january 2021 to april 2022. JAMA Intern Med 2022;182:1071-81.
DOI: https://doi.org/10.1001/jamainternmed.2022.4299
Weiss P, Murdoch DR. Clinical course and mortality risk of severe COVID-19. Lancet 2020;395:1014-5.
DOI: https://doi.org/10.1016/S0140-6736(20)30633-4
Wu Z, McGoogan JM. Characteristics of and important lessons from the coronavirus disease 2019 (COVID-19) outbreak in China. JAMA 2020;323:1239-42.
DOI: https://doi.org/10.1001/jama.2020.2648
Valencia CF, Lucero OD, Castro OC, et al. Comparison of ROX and HACOR scales to predict high-flow nasal cannula failure in patients with SARS-CoV-2 pneumonia. Sci Rep 2021;11:22559.
DOI: https://doi.org/10.1038/s41598-021-02078-5
Oczkowski S, Ergan B, Bos L, et al. ERS clinical practice guidelines: high-flow nasal cannula in acute respiratory failure. Eur Respir J 2022;59:2101574.
DOI: https://doi.org/10.1183/13993003.01574-2021
Roca O, Messika J, Caralt B, et al. Predicting success of high-flow nasal cannula in pneumonia patients with hypoxemic respiratory failure: the utility of the ROX index. J Crit Care 2016;35:200-5.
DOI: https://doi.org/10.1016/j.jcrc.2016.05.022
Myers LC, Mark D, Ley B, et al. Validation of respiratory rate-oxygenation index in patients with COVID-19–related respiratory failure. Crit Care Med 2022;50:e638-42.
DOI: https://doi.org/10.1097/CCM.0000000000005474
Cosentini R, Groff P, Brambilla AM, et al. SIMEU position paper on non-invasive respiratory support in COVID-19 pneumonia. Intern Emerg Med 2022;17:1175-89.
DOI: https://doi.org/10.1007/s11739-021-02906-6
Suliman L, Abdelgawad T, Farrag N, et al. Validity of ROX index in prediction of risk of intubation in patients with COVID-19 pneumonia. Adv Respir Med 2020;89:1-7.
DOI: https://doi.org/10.5603/ARM.a2020.0176
Rochwerg B, Brochard L, Elliott MW, et al. Official ERS/ATS clinical practice guidelines: noninvasive ventilation for acute respiratory failure. Eur Respir J 2017;50:1602426.
DOI: https://doi.org/10.1183/13993003.02426-2016
Hoogenboom WS, Pham A, Anand H, et al. Clinical characteristics of the first and second COVID-19 waves in the Bronx, New York: a retrospective cohort study. Lancet Reg Health Am 2021;3:100041.
DOI: https://doi.org/10.1016/j.lana.2021.100041
Grasselli G, Zangrillo A, Zanella A, et al. Baseline characteristics and outcomes of 1591 patients infected with SARS-CoV-2 admitted to ICUs of the Lombardy region, Italy. JAMA 2020;323:1574-81.
DOI: https://doi.org/10.1001/jama.2020.5394
Vega ML, Dongilli R, Olaizola G, et al. COVID-19 pneumonia and ROX index: time to set a new threshold for patients admitted outside the ICU. Pulmonology 2022;28:13-7.
DOI: https://doi.org/10.1016/j.pulmoe.2021.04.003
Novelli L, Raimondi F, Ghirardi A, et al. At the peak of COVID-19 age and disease severity but not comorbidities are predictors of mortality: COVID-19 burden in Bergamo, Italy. Panminerva Med 2021;63:51-61.
DOI: https://doi.org/10.23736/S0031-0808.20.04063-X
Papoutsi E, Giannakoulis VG, Xourgia E, et al. Effect of timing of intubation on clinical outcomes of critically ill patients with COVID-19: a systematic review and meta-analysis of non-randomized cohort studies. Crit Care 2021;25:121.
DOI: https://doi.org/10.1186/s13054-021-03540-6
Boscolo A, Pasin L, Sella N, et al. Outcomes of COVID-19 patients intubated after failure of non-invasive ventilation: a multicenter observational study. Sci Rep 2021;11:17730.
DOI: https://doi.org/10.21203/rs.3.rs-400059/v1
Zaboli A, Ausserhofer D, Pfeifer N, et al. The ROX index can be a useful tool for the triage evaluation of COVID‐19 patients with dyspnoea. J Adv Nurs 2021;77:3361-9.
DOI: https://doi.org/10.1111/jan.14848
Melo-Diaz LL, Kieling GA. The ROX index: “propelled” by high-flow nasal cannula therapy during the COVID-19 pandemic into greater applicability in respiratory support. Can J Respir Ther 2022;58:182-4.
DOI: https://doi.org/10.29390/cjrt-2022-012
Gattinoni L, Coppola S, Cressoni M, et al. COVID-19 does not lead to a “typical” acute respiratory distress syndrome. Am J Respir Crit Care Med 2020;201:1299-300.
DOI: https://doi.org/10.1164/rccm.202003-0817LE
Novelli L, Raimondi F, Ghirardi A, et al. Frequency, characteristics, and outcome of patients with COVID-19 pneumonia and ‘silent hypoxemia’ at admission: a severity-matched analysis. Panminerva Med 2022;64:442-51.
DOI: https://doi.org/10.23736/S0031-0808.22.04609-2
Raimondi F, Novelli L, Marchesi G, et al. Worsening of gas exchange parameters at high FiO2 in COVID-19: misleading or informative? Multidiscip Respir Med 2021;16:759.
DOI: https://doi.org/10.4081/mrm.2021.759
Colaianni-Alfonso N, Montiel GC, Castro-Sayat M, et al. ROX index to predict CPAP outcome in hypoxemic respiratory failure due to COVID-19. Intensive Care Med 2022;48:1818-9.
DOI: https://doi.org/10.1007/s00134-022-06913-9
Nova A, Rezoagli E, Eronia N, et al. Role of PEEP on the prognostic performance of the ROX index in hypoxemic respiratory failure due to COVID-19: any further gain in outcome prediction? Intensive Care Med 2023;49:355-6.
DOI: https://doi.org/10.1007/s00134-022-06965-x
Abroug F, Hammouda Z, Lahmar M, et al. Early variation of ROX index predicts high-flow nasal cannula outcome in awake subjects with severe hypoxemic COVID-19. Respir Care 2023;68:110-3.
DOI: https://doi.org/10.4187/respcare.10125
Ethics Approval
This study was approved by the respective ethics committees involved (Comitato etico di Bergamo - n.308-20, 05/02/2021; Comitato etico della Brianza - EC approval on 02/04/2021; Comitato etico di Ferrara - n.373/2021/Oss/AOUFe, 22/04/2021; Comitato etico Ospedale Sacco Milano - n.2021/ST/091, 19/04/2021; Comitato etico di Palermo - n.3/2021, 31/03/2021; Comitato etico Policlinico Milano - n.433/2021, 23/04/2021; Comitato etico San Paolo Milano - n.965, 21/04/2021; Comitato etico di Verona - n.3171CESC, 11/03/2021).How to Cite
Raimondi, Federico, Stefano Centanni, Fabrizio Luppi, Stefano Aliberti, Francesco Blasi, Paola Rogliani, Claudio Micheletto, et al. 2024. “Respiratory Rate-Oxygenation Index on the 3<sup>rd< sup> Day Is the Best Predictor of Treatment Failure in COVID-19 Patients”. Monaldi Archives for Chest Disease, October. https://doi.org/10.4081/monaldi.2024.3033.
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