tetano
Editor, Senior Moderator
J Intensive Care
. 2024 Feb 15;12(1):7.
doi: 10.1186/s40560-024-00720-8. External validation of the HACOR score and ROX index for predicting treatment failure in patients with coronavirus disease 2019 pneumonia managed on high-flow nasal cannula therapy: a multicenter retrospective observational study in Japan
Hiromu Okano[SUP] 1 2 [/SUP], Ryohei Yamamoto[SUP] 3 [/SUP], Yudai Iwasaki[SUP] 4 [/SUP], Daisuke Irimada[SUP] 4 [/SUP], Daisuke Konno[SUP] 4 [/SUP], Taku Tanaka[SUP] 5 [/SUP], Takatoshi Oishi[SUP] 6 [/SUP], Hiroki Nawa[SUP] 7 [/SUP], Akihiko Yano[SUP] 8 [/SUP], Hiroaki Taniguchi[SUP] 9 [/SUP], Masayuki Otawara[SUP] 10 [/SUP], Ayaka Matsuoka[SUP] 11 [/SUP], Masanori Yamauchi[SUP] 4 [/SUP]
Affiliations
Background: The HACOR score for predicting treatment failure includes vital signs and acid-base balance factors, whereas the ROX index only considers the respiratory rate, oxygen saturation, and fraction of inspired oxygen (FiO[SUB]2[/SUB]). We aimed to externally validate the HACOR score and ROX index for predicting treatment failure in patients with coronavirus disease 2019 (COVID-19) on high-flow nasal cannula (HFNC) therapy in Japan.
Methods: This retrospective, observational, multicenter study included patients, aged ≥ 18 years, diagnosed with COVID-19 and treated with HFNC therapy between January 16, 2020, and March 31, 2022. The HACOR score and ROX index were calculated at 2, 6, 12, 24, and 48 h after stating HFNC therapy. The primary outcome was treatment failure (requirement for intubation or occurrence of death within 7 days). We calculated the area under the receiver operating characteristic curve (AUROC) and assessed the diagnostic performance of these indicators. The 2-h time-point prediction was considered the primary analysis and that of other time-points as the secondary analysis. We also assessed 2-h time-point sensitivity and specificity using previously reported cutoff values (HACOR score > 5, ROX index < 2.85).
Results: We analyzed 300 patients from 9 institutions (median age, 60 years; median SpO[SUB]2[/SUB]/FiO[SUB]2[/SUB] ratio at the start of HFNC therapy, 121). Within 7 days of HFNC therapy, treatment failure occurred in 127 (42%) patients. The HACOR score and ROX index at the 2-h time-point exhibited AUROC discrimination values of 0.63 and 0.57 (P = 0.24), respectively. These values varied with temporal changes-0.58 and 0.62 at 6 h, 0.70 and 0.68 at 12 h, 0.68 and 0.69 at 24 h, and 0.75 and 0.75 at 48 h, respectively. The 2-h time-point sensitivity and specificity were 18% and 91% for the HACOR score, respectively, and 3% and 100% for the ROX index, respectively. Visual calibration assessment revealed well calibrated HACOR score, but not ROX index.
Conclusions: In COVID-19 patients receiving HFNC therapy in Japan, the predictive performance of the HACOR score and ROX index at the 2-h time-point may be inadequate. Furthermore, clinicians should be mindful of time-point scores owing to the variation of the models' predictive performance with the time-point. Trial registration UMIN (registration number: UMIN000050024, January 13, 2023).
Keywords: Coronavirus disease 2019; HACOR score; High-flow nasal cannula; ROX index; Tracheal intubation.
. 2024 Feb 15;12(1):7.
doi: 10.1186/s40560-024-00720-8. External validation of the HACOR score and ROX index for predicting treatment failure in patients with coronavirus disease 2019 pneumonia managed on high-flow nasal cannula therapy: a multicenter retrospective observational study in Japan
Hiromu Okano[SUP] 1 2 [/SUP], Ryohei Yamamoto[SUP] 3 [/SUP], Yudai Iwasaki[SUP] 4 [/SUP], Daisuke Irimada[SUP] 4 [/SUP], Daisuke Konno[SUP] 4 [/SUP], Taku Tanaka[SUP] 5 [/SUP], Takatoshi Oishi[SUP] 6 [/SUP], Hiroki Nawa[SUP] 7 [/SUP], Akihiko Yano[SUP] 8 [/SUP], Hiroaki Taniguchi[SUP] 9 [/SUP], Masayuki Otawara[SUP] 10 [/SUP], Ayaka Matsuoka[SUP] 11 [/SUP], Masanori Yamauchi[SUP] 4 [/SUP]
Affiliations
- PMID: 38360681
- DOI: 10.1186/s40560-024-00720-8
Background: The HACOR score for predicting treatment failure includes vital signs and acid-base balance factors, whereas the ROX index only considers the respiratory rate, oxygen saturation, and fraction of inspired oxygen (FiO[SUB]2[/SUB]). We aimed to externally validate the HACOR score and ROX index for predicting treatment failure in patients with coronavirus disease 2019 (COVID-19) on high-flow nasal cannula (HFNC) therapy in Japan.
Methods: This retrospective, observational, multicenter study included patients, aged ≥ 18 years, diagnosed with COVID-19 and treated with HFNC therapy between January 16, 2020, and March 31, 2022. The HACOR score and ROX index were calculated at 2, 6, 12, 24, and 48 h after stating HFNC therapy. The primary outcome was treatment failure (requirement for intubation or occurrence of death within 7 days). We calculated the area under the receiver operating characteristic curve (AUROC) and assessed the diagnostic performance of these indicators. The 2-h time-point prediction was considered the primary analysis and that of other time-points as the secondary analysis. We also assessed 2-h time-point sensitivity and specificity using previously reported cutoff values (HACOR score > 5, ROX index < 2.85).
Results: We analyzed 300 patients from 9 institutions (median age, 60 years; median SpO[SUB]2[/SUB]/FiO[SUB]2[/SUB] ratio at the start of HFNC therapy, 121). Within 7 days of HFNC therapy, treatment failure occurred in 127 (42%) patients. The HACOR score and ROX index at the 2-h time-point exhibited AUROC discrimination values of 0.63 and 0.57 (P = 0.24), respectively. These values varied with temporal changes-0.58 and 0.62 at 6 h, 0.70 and 0.68 at 12 h, 0.68 and 0.69 at 24 h, and 0.75 and 0.75 at 48 h, respectively. The 2-h time-point sensitivity and specificity were 18% and 91% for the HACOR score, respectively, and 3% and 100% for the ROX index, respectively. Visual calibration assessment revealed well calibrated HACOR score, but not ROX index.
Conclusions: In COVID-19 patients receiving HFNC therapy in Japan, the predictive performance of the HACOR score and ROX index at the 2-h time-point may be inadequate. Furthermore, clinicians should be mindful of time-point scores owing to the variation of the models' predictive performance with the time-point. Trial registration UMIN (registration number: UMIN000050024, January 13, 2023).
Keywords: Coronavirus disease 2019; HACOR score; High-flow nasal cannula; ROX index; Tracheal intubation.