Admission SpO and ROX index predict outcome in patients with COVID-19.

Mukhtar, A., A. Rady, A. Hasanin, ahmed lotfy, akram eladawy, A. Hussein, I. El-Hefnawy, M. Hassan, and hanan mostafa, "Admission SpO and ROX index predict outcome in patients with COVID-19.", The American journal of emergency medicine, vol. 50, pp. 106-110, 2021.


BACKGROUND: This study aimed to evaluate the accuracy of pulse oximetry-derived oxygen saturation (SpO) on room air, determined at hospital admission, as a predictor for the need for mechanical ventilatory support in patients with Coronavirus Disease-2019 (COVID-19).

METHODS: In this retrospective observational study, demographic and clinical details of the patients were obtained during ICU admission. SpO and respiratory rate (RR) on room air were determined within the first 6 h of hospital admission. As all measurements were obtained on room air, we calculated the simplified respiratory rate‑oxygenation (ROX) index by dividing the SpO by the RR. Based on the use of any assistance of mechanical ventilator (invasive or noninvasive), patients were divided into mechanical ventilation (MV) group and oxygen therapy group. The accuracy of the SpO, CT score, and ROX index to predict the need to MV were determined using the Area under receiver operating curve (AUC).

RESULTS: We included 72 critically ill patients who tested COVID-19-positive. SpO on the room air could predict any MV requirement (AUC [95% confidence interval]: 0.9 [0.8-0.96], sensitivity: 70%, specificity 100%, cut-off value ≤78%, P < 0.001). Within the MV group, the use of noninvasive ventilation (NIV) was successful in 37 (74%) patients, whereas 13 patients (26%) required endotracheal intubation. The cut-off ROX value for predicting early NIV failure was ≤1.4, with a sensitivity of 85%, a specificity of 86%, and an AUC of 0.86 (95% confidence interval of 0.73-0.94, P < 0.0001).

CONCLUSIONS: A baseline SpO ≤78% is an excellent predictor of MV requirement with a positive predictive value of 100%. Moreover, the ROX index measured within the first 6 h of hospital admission is a good indicator of early NIV failure.