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
Accepted: September 17, 2024
SUPPLEMENTARY MATERIAL: 8
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.
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
This work is licensed under a Creative Commons Attribution-NonCommercial 4.0 International License.
PAGEPress has chosen to apply the Creative Commons Attribution NonCommercial 4.0 International License (CC BY-NC 4.0) to all manuscripts to be published.
Similar Articles
- Malay Sarkar, Irappa Madabhavi, Vocal resonance: a narrative review , Monaldi Archives for Chest Disease: Early Access
- Carla Simonelli, Michele Vitacca, Beatrice Salvi, Manuela Saleri, Mara Paneroni, Comparison among three different follow-up models for obstructive sleep apnea syndrome patients: focus on the physiotherapist’s role , Monaldi Archives for Chest Disease: Early Access
- Giuliana Cimino, Enrico Vizzardi, Emiliano Calvi, Edoardo Pancaldi, Greta Pascariello, Nicola Bernardi, Angelica Cersosimo, Ludovica Amore, Riccardo M. Inciardi, Riccardo Raddino, Marco Metra, Endothelial dysfunction in COVID-19 patients assessed with Endo-PAT2000 , Monaldi Archives for Chest Disease: Vol. 92 No. 4 (2022)
- Anu Anna George, Kevin John John, Anil Jha, Ajay Kumar Mishra, Infections precipitating Takotsubo cardiomyopathy, an uncommon complication of a common infection , Monaldi Archives for Chest Disease: Vol. 93 No. 3 (2023)
- Shreyash Agrawal, Ravindra Nath, Pranav Ish, Neeraj Kumar Gupta, Rajni Gaind, Suniti Kale, Rani Gera, Anjali Dabral, Nitesh Gupta, *Other members of the Safdarjung Hospital COVID 2019 working group, Clinico-epidemiological profile of COVID-19 patients admitted during third wave of pandemic in a tertiary care hospital in New Delhi, India , Monaldi Archives for Chest Disease: Vol. 93 No. 2 (2023)
You may also start an advanced similarity search for this article.
