目的 探讨改良ROX(mROX)指数预测经鼻高流量氧疗(HFNC)治疗新冠病毒感染致急性呼吸窘迫综合征(ARDS)患者结局的价值。方法 采用回顾性观察性研究，纳入 2022 年 12 月至 2023 年 6 月兰州大学第二医院重症监护病房(ICU)收治的新冠病毒感染致ARDS且需要HFNC治疗的 57 例患者。根据是否成功撤机将患者分为HFNC失败组和HFNC成功组。记录两组患者入ICU后实验室检查、入ICU首个24h的急性生理学与慢性健康状况评分Ⅱ(APACHEⅡ)和序贯器官衰竭评分(SOFA)、HFNC治疗即刻和 6h后生命体征及动脉血气分析、治疗方案、ICU住院时间、总住院时间，电话随访患者 28d和 90d结局。采用单因素分析上述指标，将有意义的指标纳入二元多因素Logistic回归分析，分析患者HFNC失败的影响因素;绘制Kaplan-Meier生存曲线分析HFNC失败组和HFNC成功组患者 28d和 90d结局;绘制受试者工作特征曲线(ROC曲线)分析 6 h mROX指数和 6hROX指数预测患者HFNC成功的价值。结果 共纳入 57 例新冠病毒感染致ARDS患者，其中HFNC成功组 34 例，HFNC失败组 23 例。与HFNC成功组比较，HFNC失败组的降钙素原(PCT)、C-反应蛋白(CRP)、白细胞介素-6(IL-6)、血乳酸(Lac)水平及使用升压药比例、连续性肾脏替代治疗(CRRT)比例、APACHEⅡ评分和SOFA评分、治疗即刻和 6h呼吸频率(RR)均明显升高，ICU住院时间明显延长，治疗即刻氧合指数(PaO2/FiO2)及治疗即刻和 6 h SpO2、PaO2、ROX指数、mROX指数均明显降低(均P＜0。05)。Kaplan-Meier生存曲线显示，HFNC成功组患者28d累积生存率(100%比26。1%)和90d累积生存率(85。3%比21。7%)均明显高于HFNC失败组(均P＜0。001)。二元多因素Logistic回归分析显示，Lac[优势比(OR)=0。129，95%可信区间(95%CI)为0。020～0。824]、SOFA评分(OR=0。382，95%CI为0。158～0。925)、6 h ROX指数(OR=0。099，95%CI为0。011～0。920)、6 h mROX指数(OR=23。703，95%CI为1。415～396。947)与HFNC治疗结局相关(均P＜0。05)。ROC曲线分析显示，6 h mROX指数和 6hROX指数预测患者HFNC成功的ROC曲线下面积(AUC)均较高(分别为 0。809、0。714)，其中 6 h mROX指数AUC明显高于 6hROX指数(P＜0。01)，当6 h mROX指数截断值为 4。5 时，敏感度为 88。2%，特异度为 52。2%。结论 6 h mROX指数对HFNC治疗新冠病毒感染致ARDS患者结局的预测价值高于 6hROX指数，当 6 h mROX指数＞4。5 时，预测HFNC治疗成功的可能性更大。
Value of modified ROX index in predicting the outcome of patients with acute respiratory distress syndrome due to SARS-CoV-2 infection treated with high-flow nasal cannula oxygen therapy
Objective To investigate the value of the modified ROX(mROX)index in predicting the outcome of patients with acute respiratory distress syndrome(ARDS)due to SARS-CoV-2 infection treated with high-flow nasal cannula oxygen therapy(HFNC).Methods A retrospective observational study was conducted,including 57 patients with ARDS caused by SARS-CoV-2 infection who required HFNC treatment in the intensive care unit(ICU)of the Lanzhou University Second Hospital from December 2022 to June 2023.The patients were divided into HFNC failure group and HFNC success group according to whether they were successfully weaned from HFNC.Laboratory tests,acute physiology and chronic health evaluationⅡ(APACHEⅡ),and sequential organ failure assessment(SOFA)in the first 24 hours of ICU admission were recorded in both groups,vital signs and arterial blood gas analysis immediately and after 6 hours of HFNC treatment,treatment regimen,length of ICU stay,and total length of hospital stay were recorded in both groups,and patients'outcomes at 28 days and 90 days were followed up by telephone.Univariate analysis was used to analyze the above indexes,and the significant indexes were included in the binary multivariate Logistic regression analysis to analyze the influencing factors of HFNC failure in patients.Kaplan-Meier survival curves were plotted to analyze the 28-day and 90-day outcomes of patients in both groups.Receiver operator characteristic curve(ROC curve)was plotted to analyze the value of treatment 6-hour mROX index and 6-hour ROX index in predicting the success of HFNC.Results A total of 57 patients with ARDS due to SARS-CoV-2 infection were enrolled,including 34 patients in the HFNC success group and 23 patients in the HFNC failure group.Procalcitonin(PCT),C-reactive protein(CRP),interleukin-6(IL-6),lactic acid(Lac)and the proportion of vasopressors,the proportion of continuous renal replacement therapy(CRRT),the APACHEⅡscore and the SOFA score,the respiratory rate(RR)immediately and 6 hours after treatment were significantly higher in the HFNC failure group compared with the HFNC success group.The length of ICU stay was significantly longer,and oxygenation index(PaO2/FiO2)at the time of treatment,and pulse oxygen saturation(SpO2),arterial partial pressure of oxygen(PaO2),ROX index,and mROX index at the time of treatment and at 6 hours after treatment were significantly lower in the HFNC failure group compared with the HFNC success group(all P<0.05).Kaplan-Meier survival curves showed that the 28-day cumulative survival rates(100% vs.26.1% )and 90-day cumulative survival rates(85.3% vs.21.7% )of patients in the HFNC success group were significantly higher than those in the HFNC failure group(both P<0.001).On binary multivariate Logistic regression analysis,Lac[odds ratio(OR)=0.129,95% confidence interval(95% CI)was 0.020-0.824],SOFA score(OR=0.382,95% CI was 0.158-0.925),6-hour ROX index(OR=0.099,95% CI was 0.011-0.920),and 6-hour mROX index(OR=23.703,95% CI was 1.415-396.947)were associated with HFNC treatment outcome(all P<0.05).ROC curve analysis showed that the area under the ROC curve(AUC)of the 6-hour mROX index and the 6-hour ROX index for predicting the success of HFNC were both higher(0.809 and 0.714,respectively),and the AUC of 6-hour mROX index was significantly higher than that of 6-hour ROX index(P<0.01),and the sensitivity was 88.2% and the specificity was 52.2% when the cut-off value of 6-hour mROX index was 4.5.Conclusion The predictive value of the 6-hour mROX index in the treatment of patients with ARDS caused by SARS-CoV-2 infection is higher than that of the 6-hour ROX index,and the 6-hour mROX index is greater than 4.5,which is more likely to predict the success of HFNC treatment.
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