ROX index predicts high flow nasal cannula failure in COVID-19 patients with AHRF: Study
Jharkhand: Results from a recent meta-analysis suggest that the ROX index is a good predictor of high flow nasal cannula (HFNC) failure in COVID-19 patients with acute hypoxemic respiratory failure (AHRF). This may improve the clinical management and stratification of COVID-19 patients for optimal treatment. The study findings appear in the Journal of Critical Care.
Treatment of acute hypoxemic respiratory failure is important for saving lives in COVID-19 patients. HFNC oxygen therapy has been used successfully as a non-invasive procedure for AHRF management in COVID-19 patients. However, many patients suffer HFNC failure that leads to worsening of conditions. Thus, early HFNC failure prediction at the time of AHRF may improve clinical management and stratification of patients for optimal treatment.
The ROX index is a score that has been accepted in the management of pneumonia and acute respiratory distress syndrome (ARDS) and thus could have the potential to predict HFNC outcomes in COVID-19 patients.
Against the above background, JayPrakash, Rajendra Institute of Medical Sciences, Ranchi, Jharkhand, India, and colleagues performed a systematic review and meta-analysis to determine the performance of the ROX index as a predictor of HFNC failure.
For achieving their objective, the team searched the online databases for articles published till 15 June 2021 investigating the ROX index as a predictor for HFNC failure. Quality In Prognosis Studies (QUIPS) tool was used to analyze the risk of bias for prognostic factors, by two independent authors.
Key findings include:
- Eight retrospective or prospective cohort studies involving 1301 patients showed a good discriminatory value, the summary area under the curve (sAUC) 0.81 with a sensitivity of 0.70 and specificity of 0.79 for predicting HNFC failure.
- The positive and negative likelihood ratio were 3.0 and 0.37 respectively and was strongly associated with a promising predictive accuracy (Diagnostic odds ratio (DOR) 9).
The researchers conclude, "this meta-analysis suggests ROX index has good discriminating power for prediction of HFNC failure in COVID-19 patients with AHRF. Further large-scale, multicenter studies with uniform cut-offs and at specific time intervals are needed to strengthen the current findings."
Reference:
Jay Prakash, Pradip Kumar Bhattacharya, Arun Kumar Yadav, Amit Kumar, Lal Chand Tudu, Kameshwar Prasad, ROX index as a good predictor of high flow nasal cannula failure in COVID-19 patients with acute hypoxemic respiratory failure: A systematic review and meta-analysis, Journal of Critical Care, Volume 66, 2021, Pages 102-108, ISSN 0883-9441, https://doi.org/10.1016/j.jcrc.2021.08.012.
