The predictive value of ROX index related parameters for high-flow nasal cannula oxygen therapy failure in elderly patients with pneumonia-related acute hypoxemia respiratory failure
Objective:To investigate the predictive value of respiratory rate oxygenation(ROX)index,modifed ROX(mROX)index,ROX by adding heart rate(ROX-HR)index,and mROX by adding heart rate(mROX-HR)index for high-flow nasal cannula oxygen therapy(HFNC)failure in elderly patients with pneumonia-related acute hypoxemia respiratory failure(AHRF).Methods:A retrospective study was conducted to investigate clinical data of 294 elderly patients with pneumonia-related AHRF treated with HFNC in the department of intensive care unit(ICU)of the Second Affiliated Hospital of Hainan Medical University from January 2021 to June 2023.Patients were divided into the failure group(n=102)and the success group(n=192)according to whether they subse-quently received mechanical ventilation.The general data,physiological parameters,blood gas analysis parame-ters and laboratory indicators in the two groups were collected,and the ROX index,ROX-HR index,mROX in-dex and mROX-HR index were calculated at HFNC initiation and 2 h after HFNC.Univariate analysis and multi-variate logistic regression analysis were used to explore the relationship between ROX index related parameters and HFNC failure.The receiver operating characteristic(ROC)curve and decision curve analysis(DCA)were used to evaluate the predictive value and clinical practicability of ROX index related parameters for HFNC failure.Results:The rate of HFNC failure in this study was 34.69％.The age,proportion of chronic obstructive pulmonary dis-ease,proportion of cardiovascular disease,sequential organ failure assessment score,length of stay in ICU,and 28-days mortality in the failure group were higher/longer than those of the success group,and the ROX index,ROX-HR index,mROX index and mROX-HR index at 2 h after HFNC in the failure group were lower than those of the success group,with the differences were statistically significant(P＜0.05).Multivariate logistic regression analysis showed that after adjusting other related factors,the elevated value of mROX index(OR=0.550,95％CI:0.437-0.693)and mROX-HR index(OR=0.327,95％CI:0.236-0.453)at 2 h after HFNC were inde-pendent protective factors for HFNC failure in elderly patients with AHRF(P＜0.05).The ROC curve analysis showed that the area under the curve(AUC)for mROX index at 2 h after HFNC to predict HFNC failure curve was 0.742(95％CI:0.688-0.791),the best cut-off value was 5.38,the sensitivity was 65.69％,and specificity was 79.17％.The AUC for mROX-HR index at 2 h after HFNC to predict HFNC failure curve was 0.829(95％CI:0.781-0.870),the best cut-off value was 5.48,the sensitivity was 83.33％,and specificity was 88.02％.The AUC of mROX-HR index was greater than that of mROX index(Z=4.027,P＜0.001).The DCA results showed that,within the thresholds of 0.15-0.90,the net benefit rate of mROX-HR index to predicted HFNC failure was better than that of the mROX index.Conclusion:The elevated value of mROX index and mROX-HR index at 2 h after HFNC are independent protective factors for HFNC failure in elderly patients with AHRF,and have certain predictive value and clinical practicability for HFNC failure.
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