Longitudinal Assessment of ROX and HACOR Scores to Predict Non-Invasive Ventilation Failure in Patients with SARS-CoV-2 Pneumonia

	Total	NIV Success (n=179)	NIV failure (n=262)	p value
Age	60 (19–90)	54(53–58)	62(61–64)	<0.001
M:F	311:130	126:53	185:77	0.960
DM	241(54.6%)	106(59.2%)	135(56%)	0.111
HTN	268(60.8%)	103(57.5%)	165(63%)	0.251
CAD	64 (14.5%)	22(12.3%)	42(16%)	0.274
CKD	24(5.4%)	7(3.9%)	17(6.5%)	0.241
COAD	22(5%)	8(4.5%)	14(5.3%)	0.629
Symptom-admission duration (days)	7 (0–14)	3(0–8)	4(1–14)	0.783
Baseline P/F ratio	125(56–280)	145(140–156)	117(110–121)	<0.001
ARDS category				<0.001
Mild	32 (7.3%)	18(56.3%)	14(43.8%)
Moderate	282 (63.4%)	136(48.2%)	146(51.8%)
Severe	127(28.8%)	25(19.7%)	80.3%
Remedesivir	286 (64.9%)	117(65.4%)	169(64.5%)	0.853
TCZ	23 (5.2%)	11(6.1%)	12(4.6%)	0.468
Vasopressors	172(39%)	2(1.1%)	170(64.9%)	<0.001
Steroid				<0.001
Early High	283 (64.2%)	126(70.4%)	157(59.9%)
Early low	113 (25.6%)	50(27.91%)	63(14.3%)
Indeterminate	45 (10.2%)	3 (1.7%)	42(9.5%)
BSI
NG	351(79.6%)	164(91.6%)	187(71.4%)	<0.001
Gram neg	56(12.7%)	9(5%)	47(17.9%)
Positive	14 (3.2%)	3(1.7%)	11(4.2%)
Fungal	20(4.5%)	3(1.7%)	17(6.5%)
Shock	134 (30.4%)	1(0.6%)	133(50.8%)	<0.001
AKI	109(24.7%0	8(4.5%)	101(38.5%)	<0.001
SOFA	4(2–14)	3(3–4)	6(6–7)	0.0001
Baseline CRP	101(1.98–870)	75(68–98.70)	116.20(98–135)	0.006
Baseline ALC	760(120–3640)	860(760–920)	720(650–780)	<0.001
ICU LOS	9(1–90)	7(7–8)	11(10–13)	<0.001
Hospital LOS	14(1–95)	14(12–16)	14(13–15)	0.349

Patterns of ROX index and HACOR from day 1 to day 6

Receiver operating curve analysis of ROX-index and HACOR score from day 1 to day 6

Table 2.

Ventilatory parameter comparison- HACOR/ROX

	Total	Success (n=175)	Failure (n=262)	Univariate analysis OR (CI)
HACOR D1	5(0–9)	4(4–5)	6(6–7)	1.963(1.696–2.273)
ROX D1	4.13(1.9–9.27)	5.14(4.9–5.3)	3.53(3.33–3.68)	0.309(0.245–0.389)
HACOR D2	5(0–10)	3(3–4)	6(6–7)	2.735(2.250–3.325)
ROX D2	4.1(1.7–12.15)	5.62(5.36–5.85)	3.32(3.16–3.50)	0.194(0.143–0.262)
HACOR D3	5(0–9)	3(3–4)	7(7–8)	3.064(2.435–3.857)
ROX D3	4.5(1.68–13.22)	6.06(5.85–6.27)	3.3(3.13–3.50)	0.186(0.131–0.263)
HACOR D4	5(0–10)	3(3–4)	7(7–8)	3.119(2.416–4.027)
ROX D4	2.7(2–14.1)	6.08(5.83–6.50)	3.29(3.10–3.57)	0.182(0.125–0.266)
HACOR D5	4.0(0–10)	2(2–3)	7(7–8)	3.745(2.647–5.300)
ROX D5	5.2(1.95–10.47)	6.3(6.15–6.6)	2.95(2.8–3.20)	0.182(0.119–0.279)
HACOR D6	4 (0–10)	2.0(2–3)	7.5(7–8)	3.536(2.442–5.119)
ROX D6	5.4(1.5–12.65)	6.84(6.35–7.14)	2.89(2.66–3.20)	0.159(0.093–0.272)
No of days with HACOR>5	2(0–18)	1(1–2)	3(3–4)	1.87(1.58–2.09)

Table 3.

Multivariable models for NIV failure. The models were created on 327 participants having complete information about all covariates. The model diagnostics indicate the substantial reduction in error variances after theory driven sequential sections of variables

Predictors	Ref. Category. NIV_Success Odds Ratios CI p
Predictors	OR	CI	p	OR	CI	p	OR	Cl	p	OR	CI	p	OR	CI	p
R0X>4.47	0.19	0.13–26	<0.001	0,18	0.12–0.25	<0.001	0,18	0.12–0.25	<0.001	0,17	0.11–0.25	<0.001	0,15	0.09–0.23	<0.001
Age>60Yrs				5,	2.47–11.83	<0.001	5,	238–11.74	<0.001	5,	230–1158	<0.001	4,	1.66–10.18	0,003
GenderF				0,64	0.29–1.41	0,271	59	0.26–1.33	0,208	0,65	0.28–1.47	0,300	37	0.13–1.00	57
Diabetes+				0,61	0.29-1.27	0,184	59	0.28–1.25	0,170	59	0.27–1.26	0,176	55	023–1.30	0,175
Illness_ICU_IntervalT2(Int)							0,72	0.29–1.72	0,456	0,76	031–1.86	355	0,77	0.27–2.15	0,617
Illness_ICU_IntervalT3(High)							2,	0.87–5.25	0,100	222	0.90–5.62	0,086	3,	1.16–9.26	0,027
ALCDI_Tertile2(Int)										0,45	0.17–1.11	87	0,87	0.29–258	0,796
ALCDI_Tertile3(High)										0,43	0.16–1.07	0,071	0,75	0.26–2.16	585
SOFA Score													2,	1.60–2.71	<0.001
Observations	327			327			327			327			327
R2 Tjur	393			0,636			0,646			0,654			0,729
AIC	224,			209,			207,			206582			169,
log-Likelihood	−110213			−99334			−96387			−94291			−74,

[i] OR: Odds ratio; CI: Confidence interval

Table 4:

Summary of studies depicting NIV failure

Reference, Year (Country)	Setting	Modes	NIRS failure definition	HACOR score in Failure	ROX Score in Failure	NIRS Failure	Mortality	Predictors of Failure
Duan et al. 2021 (China)19	ICU (non-COPD)	NIV	Need of IMV as rescue therapy	7 (at initiation) 5 (at 1–2 hours)		14.7 %	9.4 %	HACOR score, Duration of NIV, Heart rate, pH, GCS, Mean Arterial BP, P/F ratio, PaCO2
Guia et al. 2021 (Italy, Portugal, USA)15	ICU (COVID)	NIV (CPAP)	Need of IMV as rescue therapy and Death	5		27.3 %	23 %	HACOR score, Age, P/F ratio
Valencia et al. 2021 (Colombia)13	Emergency Department	HFNC (COVID)	Need of IMV as rescue therapy and Death	7.14 ±3.6	5.61 ±4.1	62.0 %	29.3 %	HACOR score, GCS, ROX index, Heart Rate, Respiratory Rate, PaCO2, SaO2, pH, PaO2, P/F ratio, Chronic Kidney Disease, Co-Infections
Jog S et al. 2021 (India)20	ICU (COVID)	NIV/HFNC	Need of IMV as rescue therapy and Death			64.1 %	56.9 %	Age, Medical Comorbidities, Admission SpO2, Non-Respiratory organ dysfunction
Prakash J et al. 2021 (Meta-analysis)16	ICU (COVID)	HFNC			5 (24 hr)			ROX score
Prakash J et al. 2021 (Meta-analysis)16	ICU (COVID)	HFNC			5 (24 hr)			ROX score
Khan MS et al., 2022 (India)21	ICU (COVID)	HFNC	Need of NIV or IMV as rescue therapy		3.4 ± 0.4 (1 hr) 4.4 ± 0.9 (6 hr)	28.9 %	27.1 % (28-day)	Age, APACHE ll, SOFA, Lag time to HFNC, Duration of HFNC, ICU LOS, PF ratio, ROX index, D-dimer, IL-6, RBS, Admission SpO2
Santus et al. 2022 (Italy)14	HDU (COVID)	CPAP (Helmet)	Need of IMV as rescue therapy, Transfer to ICU and Death	5 (1 hr)	6.2 (4.7–7.7) (1hr) mROX 5.8 (3.8–8.9) (1 hr)	38.4 %	12.4 %	Age, Ischaemic Heart Disease, COPD, CPAP duration, Hospital LOS, WBC count, D-dimer, CRP, PEEP, FiO2, PF ratio, Respiratory rate, A-a O2 gradient, GCS, ROX index, mROX index, HACOR score PaCO2,
Chacko et al. 2022 (India)18	ICU (COVID)	NIV	Need of IMV as rescue therapy or Death			36.4 %	30.1 %	Age, Disease Severity, Admission PF ratio, Respiratory Rate, High CK-MB, Need for organ support, Duration of continuous NIV, ICU LOS and hospital LOS

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DOI: https://doi.org/10.2478/jccm-2024-0013 | Journal eISSN: 2393-1817 | Journal ISSN: 2393-1809

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Language: English

Page range: 147 - 157

Submitted on: Aug 1, 2023

Accepted on: Jan 30, 2024

Published on: Apr 30, 2024

Published by: University of Medicine, Pharmacy, Science and Technology of Targu Mures

In partnership with: Paradigm Publishing Services

Publication frequency: 4 issues per year

Keywords:

non-invasive ventilation,

HACOR,

ROX,

Related subjects:

Internal medicine, other,

Surgery,

Surgery, other,

Anaesthesiology,

Emergency medicine and intensive-care medicine

© 2024 Abhijeet Anand, Sai Teja Kodamanchili, Ankur Joshi, Rajnish Joshi, Jai Prakash Sharma, Goyal Abhishek, Abhijit P Pakhare, Yogesh Niwariya, Rajesh Panda, Sunaina T Karna, Alkesh K Khurana, Saurabh Saigal, published by University of Medicine, Pharmacy, Science and Technology of Targu Mures
This work is licensed under the Creative Commons Attribution 4.0 License.

Volume 10 (2024): Issue 2 (April 2024)

Longitudinal Assessment of ROX and HACOR Scores to Predict Non-Invasive Ventilation Failure in Patients with SARS-CoV-2 Pneumonia

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