{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,11,5]],"date-time":"2026-11-05T11:00:16Z","timestamp":1793876416061,"version":"4.7.0"},"reference-count":16,"publisher":"Public Library of Science (PLoS)","issue":"2","license":[{"start":{"date-parts":[[2024,2,15]],"date-time":"2024-02-15T00:00:00Z","timestamp":1707955200000},"content-version":"vor","delay-in-days":0,"URL":"http:\/\/creativecommons.org\/licenses\/by\/4.0\/"}],"funder":[{"name":"Faculty of Medicine, Thammasat University, Thailand"}],"content-domain":{"domain":["www.plosone.org"],"crossmark-restriction":false},"short-container-title":["PLoS ONE"],"abstract":"\nBackground<\/jats:title>\nHigh-flow nasal cannula (HFNC) therapy is commonly used to treat acute respiratory failure in patients with COVID-19 pneumonia. However, predictors of successful weaning from HFNC in these patients has not been investigated.<\/jats:p>\n<\/jats:sec>\n\nObjective<\/jats:title>\nTo assess predictors of successful separation from HFNC in patients with COVID-19 pneumonia.<\/jats:p>\n<\/jats:sec>\n\nMethods<\/jats:title>\nWe conducted a retrospective cohort study at a university hospital in Thailand. Patients with COVID-19 pneumonia requiring HFNC therapy between April 2020 and June 2022 were included. ROX index was defined as the ratio of oxygen saturation (SpO2<\/jats:sub>) \/ fraction of inspired oxygen (FiO2<\/jats:sub>) to respiratory rate. Heart-ROX (HROX) index was defined as ROX multiplied by heart rate (HR) improvement. HR improvement (delta-HR) was defined as a percentage of the difference between the baseline HR and the morning HR at HFNC weaning day 1 divided by the baseline HR. Weaning success was defined as ability to sustain spontaneous breathing after separation from HFNC without any invasive or non-invasive ventilatory support for \u226548 hours or death.<\/jats:p>\n<\/jats:sec>\n\nResults<\/jats:title>\nA total of 164 patients (54% male) were included. Mean age was 61.1\u00b116.1 years. Baseline SpO2<\/jats:sub>\/FiO2<\/jats:sub> was 265.3\u00b1110.8. HFNC weaning success was 77.4%. The best cut-off value of ROX index to predict HFNC weaning success was 7.88 with 100% sensitivity, 97.3% specificity, and area under the ROC curve (AUC) of 0.98 (95% CI: 0.937\u20131.000, p<0.001). The best cut-off value of delta-HR 3.7 with 88.2% sensitivity, 75.7% specificity, and AUC of 0.83 (95% CI: 0.748\u20130.919, p<0.001). The best cut-off value of HROX index was 59.2 with 88.2% sensitivity, 81.1% specificity, and AUC of 0.89, (95% CI: 0.835\u20130.953, p<0.001).<\/jats:p>\n<\/jats:sec>\n\nConclusions<\/jats:title>\nThe ROX index has the highest accuracy for predicting successful weaning off HFNC treatment in patients with COVID-19 pneumonia. While HROX and delta-HR indices can serve as alternative tools, it is recommended to verify these indices and determine the optimal cut-off value for determining separation from HFNC therapy through a large prospective cohort study.<\/jats:p>\n<\/jats:sec>\n\nTrial registration<\/jats:title>\nClinicaltrials.in.th number:<\/jats:bold> TCTR20221108004<\/jats:ext-link>.<\/jats:p>\n<\/jats:sec>","DOI":"10.1371\/journal.pone.0297624","type":"journal-article","created":{"date-parts":[[2024,2,15]],"date-time":"2024-02-15T18:38:26Z","timestamp":1708022306000},"page":"e0297624","update-policy":"https:\/\/doi.org\/10.1371\/journal.pone.corrections_policy","source":"Crossref","is-referenced-by-count":9,"title":["Comparison of ROX, HROX, and delta-HR indices to predict successful weaning from high-flow oxygen therapy in hospitalized patients with COVID-19 pneumonia"],"prefix":"10.1371","volume":"19","author":[{"ORCID":"https:\/\/orcid.org\/0000-0002-1207-2189","authenticated-orcid":true,"given":"Pitchayapa","family":"Ruchiwit","sequence":"first","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Jaturong","family":"Madua","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0003-2462-9471","authenticated-orcid":true,"given":"Narongkorn","family":"Saiphoklang","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"340","published-online":{"date-parts":[[2024,2,15]]},"reference":[{"key":"pone.0297624.ref001","doi-asserted-by":"crossref","first-page":"428","DOI":"10.1111\/all.14657","article-title":"Risk factors for severe and critically ill COVID\u201019 patients: a review","volume":"76","author":"Gao Yd","year":"2021","journal-title":"Allergy"},{"key":"pone.0297624.ref002","doi-asserted-by":"crossref","first-page":"2185","DOI":"10.1056\/NEJMoa1503326","article-title":"High-flow oxygen through nasal cannula in acute hypoxemic respiratory failure","volume":"372","author":"J-P Frat","year":"2015","journal-title":"New England Journal of Medicine"},{"key":"pone.0297624.ref003","first-page":"2020","article-title":"Noninvasive respiratory support in acute hypoxemic respiratory failure associated with COVID-19 and other viral infections.","author":"C Crimi","year":"2020"},{"key":"pone.0297624.ref004","doi-asserted-by":"crossref","first-page":"909","DOI":"10.4187\/respcare.08631","article-title":"High-flow nasal cannula therapy in COVID-19: using the ROX index to predict success.","volume":"66","author":"A Chandel","year":"2021","journal-title":"Respiratory care"},{"key":"pone.0297624.ref005","first-page":"227","article-title":"High-flow nasal cannula and COVID-19: a clinical 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observational study","volume":"27","author":"B Sztrymf","year":"2012","journal-title":"Journal of critical care"},{"key":"pone.0297624.ref012","doi-asserted-by":"crossref","first-page":"1368","DOI":"10.1164\/rccm.201803-0589OC","article-title":"An index combining respiratory rate and oxygenation to predict outcome of nasal high-flow therapy","volume":"199","author":"O Roca","year":"2019","journal-title":"American journal of respiratory and critical care medicine"},{"key":"pone.0297624.ref013","first-page":"e29062","article-title":"Utility of the ROX Index in Predicting Intubation for Patients With COVID-19\u2013Related Hypoxemic Respiratory Failure Receiving High-Flow Nasal Therapy: Retrospective Cohort Study.","volume":"2","author":"M Patel","year":"2021"},{"key":"pone.0297624.ref014","doi-asserted-by":"crossref","first-page":"324","DOI":"10.1186\/s12890-020-01354-w","article-title":"Application of high-flow nasal cannula in hypoxemic patients with COVID-19: a retrospective cohort study.","volume":"20","author":"M Hu","year":"2020","journal-title":"BMC Pulm Med."},{"key":"pone.0297624.ref015","doi-asserted-by":"crossref","first-page":"1","DOI":"10.1186\/s40560-021-00538-8","article-title":"Predictors of failure with high-flow nasal oxygen therapy in COVID-19 patients with acute respiratory failure: a multicenter observational study","volume":"9","author":"R Mellado-Artigas","year":"2021","journal-title":"Journal of Intensive Care"},{"key":"pone.0297624.ref016","first-page":"1","article-title":"Early prediction of high flow nasal cannula therapy outcomes using a modified ROX index incorporating heart rate","volume":"8","author":"KJ Goh","year":"2020","journal-title":"Journal of intensive care"}],"container-title":["PLOS 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