Elsevier

Journal of Critical Care

Volume 66, December 2021, Pages 102-108
Journal of Critical Care

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

https://doi.org/10.1016/j.jcrc.2021.08.012Get rights and content

Highlights

  • Prediction of HFNC failure in COVID-19 patients with AHRF may improve clinical management.

  • Eight retrospective or prospective cohort studies involving 1301 patients met the eligibility criteria and were reviewed.

  • The review showed that performance of ROX index as a predictor of HFNC failure.

  • ROX index has good discriminating power for prediction of HFNC failure in COVID-19 patients with AHRF.

Abstract

Purpose

Prediction of high flow nasal cannula (HFNC) failure in COVID-19 patients with acute hypoxemic respiratory failure (AHRF) may improve clinical management and stratification of patients for optimal treatment. We performed a systematic review and meta-analysis to determine performance of ROX index as a predictor of HFNC failure.

Materials and methods

Systematic search was performed in electronic databases (PubMed, Google Scholar, Web of Science and Cochrane Library) for articles published till 15 June 2021 investigating ROX index as a predictor for HFNC failure. Quality In Prognosis Studies (QUIPS) tool was used to analyze risk of bias for prognostic factors, by two independent authors.

Results

Eight retrospective or prospective cohort studies involving 1301 patients showed a good discriminatory value, summary area under the curve (sAUC) 0.81 (95% CI, 0.77–0.84) with sensitivity of 0.70 (95% CI, 0.59–0.80) and specificity of 0.79 (95% CI, 0.67–0.88) for predicting HNFC failure. The positive and negative likelihood ratio were 3.0 (95% CI, 2.2–5.3) and 0.37 (95% CI, 0.28–0.50) respectively, and was strongly associated with a promising predictive accuracy (Diagnostic odds ratio (DOR) 9, 95% CI, 5–16).

Conclusion

This meta-analysis suggests ROX index has good discriminating power for prediction of HFNC failure in COVID-19 patients with AHRF.

Keywords

High flow nasal cannula
ROX index
Acute hypoxemic respiratory failure
COVID-19

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