{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2025,10,9]],"date-time":"2025-10-09T16:39:15Z","timestamp":1760027955357,"version":"3.40.5"},"reference-count":22,"publisher":"Wiley","license":[{"start":{"date-parts":[[2023,2,8]],"date-time":"2023-02-08T00:00:00Z","timestamp":1675814400000},"content-version":"unspecified","delay-in-days":0,"URL":"https:\/\/creativecommons.org\/licenses\/by\/4.0\/"}],"content-domain":{"domain":[],"crossmark-restriction":false},"short-container-title":["Canadian Respiratory Journal"],"published-print":{"date-parts":[[2023,2,8]]},"abstract":"<jats:p>Background. High-flow nasal cannula (HFNC) is an oxygen delivery method shown to reduce the risk of intubation and mortality in patients with type 1 respiratory failure. The ROX-index score can predict HFNC failure. This study aims to evaluate sequential ROX-index assessments as predictors of HFNC failure and mortality. Methods. Prospective observational single-center study including all adult patients with positive SARS-CoV-2 PCR placed under HFNC from 1st November 2020 to 31st May 2021, and patients with hemodynamic instability or unable to tolerate HFNC were excluded. The primary endpoint was successful HFNC de-escalation. Results. In univariate analysis, HFNC de-escalation was associated with younger age (59.2\u2009\u00b1\u200914 vs. 67.7\u2009\u00b1\u200910.5 and <jats:inline-formula>\n                     <a:math xmlns:a=\"http:\/\/www.w3.org\/1998\/Math\/MathML\" id=\"M1\">\n                        <a:mi>p<\/a:mi>\n                        <a:mo>&lt;<\/a:mo>\n                        <a:mn>0.001<\/a:mn>\n                     <\/a:math>\n                  <\/jats:inline-formula>), lower levels of serum lactate (1.1 vs. 1.5 and <jats:inline-formula>\n                     <c:math xmlns:c=\"http:\/\/www.w3.org\/1998\/Math\/MathML\" id=\"M2\">\n                        <c:mi>p<\/c:mi>\n                        <c:mo>=<\/c:mo>\n                        <c:mn>0.013<\/c:mn>\n                     <\/c:math>\n                  <\/jats:inline-formula>), and higher ROX-index at 12\u2009hrs (5.09 vs. 4.13 and <jats:inline-formula>\n                     <e:math xmlns:e=\"http:\/\/www.w3.org\/1998\/Math\/MathML\" id=\"M3\">\n                        <e:mi>p<\/e:mi>\n                        <e:mo>&lt;<\/e:mo>\n                        <e:mn>0.001<\/e:mn>\n                     <\/e:math>\n                  <\/jats:inline-formula>). ROC curve analysis of ROX-index at 12\u2009hrs yielded a c-statistic of 71.2% (95% CI 61.6\u201380.9 and <jats:inline-formula>\n                     <g:math xmlns:g=\"http:\/\/www.w3.org\/1998\/Math\/MathML\" id=\"M4\">\n                        <g:mi>p<\/g:mi>\n                        <g:mo>&lt;<\/g:mo>\n                        <g:mn>0.001<\/g:mn>\n                     <\/g:math>\n                  <\/jats:inline-formula>). ROX-index at 12\u2009hrs and age retained significance in multivariate analysis. Using an optimal cutoff point of 4.43, we calculated a sensitivity of 64.5% and specificity of 69.6%. In univariate survival analysis, older age (68.8\u2009\u00b1\u20099.7 vs. 58.9\u2009\u00b1\u200913.9 and <jats:inline-formula>\n                     <i:math xmlns:i=\"http:\/\/www.w3.org\/1998\/Math\/MathML\" id=\"M5\">\n                        <i:mi>p<\/i:mi>\n                        <i:mo>&lt;<\/i:mo>\n                        <i:mn>0.001<\/i:mn>\n                     <\/i:math>\n                  <\/jats:inline-formula>), greater creatinine values (0.96 vs. 0.84 and <jats:inline-formula>\n                     <k:math xmlns:k=\"http:\/\/www.w3.org\/1998\/Math\/MathML\" id=\"M6\">\n                        <k:mi>p<\/k:mi>\n                        <k:mo>=<\/k:mo>\n                        <k:mn>0.022<\/k:mn>\n                     <\/k:math>\n                  <\/jats:inline-formula>), greater SOFA score (<jats:inline-formula>\n                     <m:math xmlns:m=\"http:\/\/www.w3.org\/1998\/Math\/MathML\" id=\"M7\">\n                        <m:mi>p<\/m:mi>\n                        <m:mo>=<\/m:mo>\n                        <m:mn>0.039<\/m:mn>\n                     <\/m:math>\n                  <\/jats:inline-formula>), and a lower 12\u2009hrs ROX-index (4.22 vs. 4.95 and <jats:inline-formula>\n                     <o:math xmlns:o=\"http:\/\/www.w3.org\/1998\/Math\/MathML\" id=\"M8\">\n                        <o:mi>p<\/o:mi>\n                        <o:mo>=<\/o:mo>\n                        <o:mn>0.02<\/o:mn>\n                     <\/o:math>\n                  <\/jats:inline-formula>) were associated with hospital mortality. The SOFA score and age retained significance in multivariate survival analysis. Conclusion. ROX-index is proven to be a valuable and easy-to-use tool for clinicians in the assessment of COVID-19 patients under HFNC.<\/jats:p>","DOI":"10.1155\/2023\/7474564","type":"journal-article","created":{"date-parts":[[2023,2,9]],"date-time":"2023-02-09T01:05:19Z","timestamp":1675904719000},"page":"1-7","source":"Crossref","is-referenced-by-count":4,"title":["Validation of Sequential ROX-Index Score Beyond 12\u2009Hours in Predicting Treatment Failure and Mortality in COVID-19 Patients Receiving Oxygen via High-Flow Nasal Cannula"],"prefix":"10.1155","volume":"2023","author":[{"ORCID":"https:\/\/orcid.org\/0000-0002-0686-872X","authenticated-orcid":true,"given":"Dimitris","family":"Basoulis","sequence":"first","affiliation":[{"name":"Infectious Diseases and COVID-19 Unit, Athens, Greece"},{"name":"1st Internal Medicine Department, Athens, Greece"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"ORCID":"https:\/\/orcid.org\/0000-0001-9952-1903","authenticated-orcid":true,"given":"Pantelis","family":"Avramopoulos","sequence":"additional","affiliation":[{"name":"1st Internal Medicine Department, Athens, Greece"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-4133-8441","authenticated-orcid":true,"given":"Maria","family":"Aggelara","sequence":"additional","affiliation":[{"name":"1st Propaedeutic Internal Medicine Department, Athens, Greece"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-8870-6475","authenticated-orcid":true,"given":"Georgios","family":"Karamanakos","sequence":"additional","affiliation":[{"name":"Infectious Diseases and COVID-19 Unit, Athens, Greece"},{"name":"1st Propaedeutic Internal Medicine Department, Athens, Greece"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"ORCID":"https:\/\/orcid.org\/0000-0003-2553-7317","authenticated-orcid":true,"given":"Pantazis-Michail","family":"Voutsinas","sequence":"additional","affiliation":[{"name":"Infectious Diseases and COVID-19 Unit, Athens, Greece"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"ORCID":"https:\/\/orcid.org\/0000-0003-0308-3553","authenticated-orcid":true,"given":"Amalia","family":"Karapanou","sequence":"additional","affiliation":[{"name":"Infection Control Nurse, Athens, Greece"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-3000-8447","authenticated-orcid":true,"given":"Mina","family":"Psichogiou","sequence":"additional","affiliation":[{"name":"1st Internal Medicine Department, Athens, Greece"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"ORCID":"https:\/\/orcid.org\/0000-0001-9630-9712","authenticated-orcid":true,"given":"Michalis","family":"Samarkos","sequence":"additional","affiliation":[{"name":"1st Internal Medicine Department, Athens, Greece"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"ORCID":"https:\/\/orcid.org\/0000-0003-3369-876X","authenticated-orcid":true,"given":"Foteini","family":"Ntziora","sequence":"additional","affiliation":[{"name":"1st Propaedeutic Internal Medicine Department, Athens, Greece"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"ORCID":"https:\/\/orcid.org\/0000-0001-6955-3453","authenticated-orcid":true,"given":"Nikolaos V.","family":"Sipsas","sequence":"additional","affiliation":[{"name":"Infectious Diseases and COVID-19 Unit, Athens, Greece"},{"name":"Department of Pathophysiology, Medical School, National and Kapodistrian University of Athens \u201cLaiko\u201d General Hospital, Athens, Greece"}],"role":[{"role":"author","vocabulary":"crossref"}]}],"member":"311","reference":[{"key":"1","doi-asserted-by":"publisher","DOI":"10.1097\/ALN.0000000000003296"},{"key":"2","doi-asserted-by":"publisher","DOI":"10.1164\/rccm.201701-0006ED"},{"issue":"4","key":"3","first-page":"408","article-title":"High-flow oxygen therapy in acute respiratory failure","volume":"55","author":"O. 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