{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,10,30]],"date-time":"2026-10-30T17:23:59Z","timestamp":1793381039245,"version":"4.5.0"},"reference-count":49,"publisher":"MDPI AG","issue":"6","license":[{"start":{"date-parts":[[2022,6,6]],"date-time":"2022-06-06T00:00:00Z","timestamp":1654473600000},"content-version":"vor","delay-in-days":0,"URL":"https:\/\/creativecommons.org\/licenses\/by\/4.0\/"}],"content-domain":{"domain":[],"crossmark-restriction":false},"short-container-title":["Medicina"],"abstract":"<jats:p>Background and Objective: Respiratory assistance tactic that is best for COVID-19-associated acute hypoxemic respiratory failure (AHRF) individuals has yet to be determined. Patients with AHRF may benefit from the use of a high-flow nasal cannula (HFNC) and non-invasive ventilation (NIV). The goals of this prospective observational research were to estimate predictive factors for HFNC and NIV failure in COVID-19-related AHRF subjects. Materials and Methods: The research enlisted the participation of 124 patients. A stepwise treatment approach was used. HFNC and NIV were used on 124 (100%) and 64 (51.6%) patients, respectively. Thirty (24.2%) of 124 patients were intubated and received invasive mechanical ventilation. Results: 85 (68.5%) patients were managed successfully. Patients who required NIV exhibited a higher prevalence of treatment failure (70.3% vs. 51.6%, p = 0.019) and had higher mortality (59.4% vs. 31.5%, p = 0.001) than patients who received HFNC. Using logistic regression, the respiratory rate oxygenation (ROX) index at 24 h (odds ratio (OR) = 0.74, p = 0.018) and the Charlson Comorbidity Index (CCI) (OR = 1.60, p = 0.003) were found to be predictors of HFNC efficacy. It was the ROX index at 24 h and the CCI optimum cut-off values for HFNC outcome that were 6.1 (area under the curve (AUC) = 0.73) and 2.5 (AUC = 0.68), respectively. Serum ferritin level (OR = 0.23, p = 0.041) and lymphocyte count (OR = 1.03, p = 0.01) were confirmed as predictors of NIV failure. Serum ferritin level at a cut-off value of 456.2 ng\/mL (AUC = 0.67) and lymphocyte count lower than 0.70 per mm3, (AUC = 0.70) were associated with NIV failure with 70.5% sensitivity, 68.7% specificity and sensitivity of 84.1%, specificity of 56.2%, respectively. Conclusion: The ROX index at 24 h, CCI, as well as serum ferritin level, and lymphocyte count can be used as markers for HFNC and NIV failure, respectively, in SARS-CoV-2-induced AHRF patients.<\/jats:p>","DOI":"10.3390\/medicina58060769","type":"journal-article","created":{"date-parts":[[2022,6,7]],"date-time":"2022-06-07T00:10:33Z","timestamp":1654560633000},"page":"769","update-policy":"https:\/\/doi.org\/10.3390\/mdpi_crossmark_policy","source":"Crossref","is-referenced-by-count":6,"title":["Predictors of Noninvasive Respiratory Support Failure in COVID-19 Patients: A Prospective Observational Study"],"prefix":"10.3390","volume":"58","author":[{"given":"Rolandas","family":"Zablockis","sequence":"first","affiliation":[{"name":"Clinic of Chest Diseases, Immunology and Allergology, Institute of Clinical Medicine, Vilnius University, M.K. Ciurlionio 21, 03101 Vilnius, Lithuania"},{"name":"Centre of Pulmonology and Allergology, Vilnius University Hospital Santaros Klinikos, Santariskiu St. 2, 08661 Vilnius, Lithuania"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Goda","family":"\u0160lekyt\u0117","sequence":"additional","affiliation":[{"name":"Clinic of Chest Diseases, Immunology and Allergology, Institute of Clinical Medicine, Vilnius University, M.K. Ciurlionio 21, 03101 Vilnius, Lithuania"},{"name":"Centre of Pulmonology and Allergology, Vilnius University Hospital Santaros Klinikos, Santariskiu St. 2, 08661 Vilnius, Lithuania"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"R\u016bta","family":"Mere\u0161kevi\u010dien\u0117","sequence":"additional","affiliation":[{"name":"Centre of Pulmonology and Allergology, Vilnius University Hospital Santaros Klinikos, Santariskiu St. 2, 08661 Vilnius, Lithuania"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Karolina","family":"K\u0117velaitien\u0117","sequence":"additional","affiliation":[{"name":"Clinic of Chest Diseases, Immunology and Allergology, Institute of Clinical Medicine, Vilnius University, M.K. Ciurlionio 21, 03101 Vilnius, Lithuania"},{"name":"Centre of Pulmonology and Allergology, Vilnius University Hospital Santaros Klinikos, Santariskiu St. 2, 08661 Vilnius, Lithuania"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Birut\u0117","family":"Zablockien\u0117","sequence":"additional","affiliation":[{"name":"Clinic of Infectious Diseases and Dermatovenerology, Institute of Clinical Medicine, Vilnius University, M.K. Ciurlionio 21, 03101 Vilnius, Lithuania"},{"name":"Centre of Infectious Diseases, Vilnius University Hospital Santaros Klinikos, Santariskiu St. 2, 08661 Vilnius, Lithuania"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Edvardas","family":"Danila","sequence":"additional","affiliation":[{"name":"Clinic of Chest Diseases, Immunology and Allergology, Institute of Clinical Medicine, Vilnius University, M.K. Ciurlionio 21, 03101 Vilnius, Lithuania"},{"name":"Centre of Pulmonology and Allergology, Vilnius University Hospital Santaros Klinikos, Santariskiu St. 2, 08661 Vilnius, Lithuania"}],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"1968","published-online":{"date-parts":[[2022,6,6]]},"reference":[{"key":"ref_1","doi-asserted-by":"crossref","first-page":"1708","DOI":"10.1056\/NEJMoa2002032","article-title":"Clinical Characteristics of Coronavirus Disease 2019 in China","volume":"382","author":"Guan","year":"2020","journal-title":"N. Engl. J. Med."},{"key":"ref_2","doi-asserted-by":"crossref","first-page":"775224","DOI":"10.3389\/fpubh.2021.775224","article-title":"The Disease Severity and Clinical Outcomes of the SARS-CoV-2 Variants of Concern","volume":"9","author":"Lin","year":"2021","journal-title":"Front. Public Health"},{"key":"ref_3","doi-asserted-by":"crossref","first-page":"e1079","DOI":"10.1097\/CCM.0000000000004558","article-title":"High-Flow Nasal Oxygen in Coronavirus Disease 2019 Patients with Acute Hypoxemic Respiratory Failure: A Multicenter, Retrospective Cohort Study","volume":"48","author":"Xia","year":"2020","journal-title":"Crit. Care Med."},{"key":"ref_4","doi-asserted-by":"crossref","unstructured":"Rorat, M., Szymanski, W., Jurek, T., Karczewski, M., Zelig, J., and Simon, K. (2021). When Conventional Oxygen Therapy Fails-The Effectiveness of High-Flow Nasal Oxygen Therapy in Patients with Respiratory Failure in the Course of COVID-19. J. Clin. Med., 10.","DOI":"10.3390\/jcm10204751"},{"key":"ref_5","doi-asserted-by":"crossref","first-page":"n436","DOI":"10.1136\/bmj.n436","article-title":"Severe COVID-19 pneumonia: Pathogenesis and clinical management","volume":"372","author":"Attaway","year":"2021","journal-title":"BMJ"},{"key":"ref_6","doi-asserted-by":"crossref","first-page":"25","DOI":"10.1097\/MCC.0000000000000902","article-title":"Noninvasive respiratory support for acute respiratory failure due to COVID-19","volume":"28","author":"Menga","year":"2022","journal-title":"Curr. Opin. Crit. Care"},{"key":"ref_7","doi-asserted-by":"crossref","first-page":"1039","DOI":"10.1164\/rccm.202005-2007LE","article-title":"High-Flow Nasal Cannula in Critically III Patients with Severe COVID-19","volume":"202","author":"Demoule","year":"2020","journal-title":"Am. J. Respir. Crit. Care Med."},{"key":"ref_8","doi-asserted-by":"crossref","first-page":"e0415","DOI":"10.1097\/CCE.0000000000000415","article-title":"Timing of Intubation in Coronavirus Disease 2019: A Study of Ventilator Mechanics, Imaging, Findings, and Outcomes","volume":"3","author":"Bavishi","year":"2021","journal-title":"Crit. Care Explor."},{"key":"ref_9","doi-asserted-by":"crossref","first-page":"ofab376","DOI":"10.1093\/ofid\/ofab376","article-title":"Critical Review of the Scientific Evidence and Recommendations in COVID-19 Management Guidelines","volume":"8","author":"Xie","year":"2021","journal-title":"Open Forum Infect. Dis."},{"key":"ref_10","doi-asserted-by":"crossref","first-page":"57","DOI":"10.1001\/jama.2020.9524","article-title":"Association of Noninvasive Oxygenation Strategies with All-Cause Mortality in Adults with Acute Hypoxemic Respiratory Failure: A Systematic Review and Meta-analysis","volume":"324","author":"Ferreyro","year":"2020","journal-title":"JAMA"},{"key":"ref_11","doi-asserted-by":"crossref","first-page":"58","DOI":"10.1186\/s13054-021-03469-w","article-title":"High-flow nasal oxygen in patients with COVID-19-associated acute respiratory failure","volume":"25","author":"Ferreyro","year":"2021","journal-title":"Crit. Care"},{"key":"ref_12","doi-asserted-by":"crossref","first-page":"521","DOI":"10.1159\/000509104","article-title":"Position Paper for the State-of-the-Art Application of Respiratory Support in Patients with COVID-19","volume":"99","author":"Pfeifer","year":"2020","journal-title":"Respiration"},{"key":"ref_13","doi-asserted-by":"crossref","first-page":"17","DOI":"10.1186\/1751-0473-3-17","article-title":"Purposeful selection of variables in logistic regression","volume":"3","author":"Bursac","year":"2008","journal-title":"Source Code Biol. Med."},{"key":"ref_14","first-page":"100768","article-title":"Respiratory support in patients with COVID-19 (outside intensive care unit). A position paper of the Respiratory Support and Chronic Care Group of the French Society of Respiratory Diseases","volume":"78","author":"Rabec","year":"2020","journal-title":"Respir. Med. Res."},{"key":"ref_15","doi-asserted-by":"crossref","first-page":"779","DOI":"10.1111\/crj.13361","article-title":"Effectiveness of noninvasive ventilation in COVID-19 related-acute respiratory distress syndrome","volume":"15","author":"Menzella","year":"2021","journal-title":"Clin. Respir. J."},{"key":"ref_16","doi-asserted-by":"crossref","first-page":"78","DOI":"10.1186\/s13613-020-00692-6","article-title":"Caution about early intubation and mechanical ventilation in COVID-19","volume":"10","author":"Tobin","year":"2020","journal-title":"Ann. Intensive Care"},{"key":"ref_17","doi-asserted-by":"crossref","first-page":"e0329","DOI":"10.1097\/CCE.0000000000000329","article-title":"Association Between Early Invasive Mechanical Ventilation and Day-60 Mortality in Acute Hypoxemic Respiratory Failure Related to Coronavirus Disease-2019 Pneumonia","volume":"3","author":"Dupuis","year":"2021","journal-title":"Crit. Care Explor."},{"key":"ref_18","first-page":"e19620","article-title":"Effect of Intubation Timing on the Outcome of Patients with Severe Respiratory Distress Secondary to COVID-19 Pneumonia","volume":"13","author":"Fayed","year":"2021","journal-title":"Cureus"},{"key":"ref_19","doi-asserted-by":"crossref","first-page":"103","DOI":"10.1016\/j.ajem.2021.01.068","article-title":"Non-invasive positive pressure ventilation versus endotracheal intubation in treatment of COVID-19 patients requiring ventilatory support","volume":"43","author":"Daniel","year":"2021","journal-title":"Am. J. Emerg. Med."},{"key":"ref_20","doi-asserted-by":"crossref","first-page":"2052","DOI":"10.1001\/jama.2020.6775","article-title":"Presenting Characteristics, Comorbidities, and Outcomes Among 5700 Patients Hospitalized With COVID-19 in the New York City Area","volume":"323","author":"Richardson","year":"2020","journal-title":"JAMA"},{"key":"ref_21","doi-asserted-by":"crossref","first-page":"497","DOI":"10.1016\/S0140-6736(20)30183-5","article-title":"Clinical features of patients infected with 2019 novel coronavirus in Wuhan, China","volume":"395","author":"Huang","year":"2020","journal-title":"Lancet"},{"key":"ref_22","doi-asserted-by":"crossref","first-page":"183","DOI":"10.1016\/j.ajem.2021.12.046","article-title":"Strategies for monitoring and predicting failure to high-flow nasal cannula therapy in the ED","volume":"57","author":"Gallardo","year":"2021","journal-title":"Am. J. Emerg. Med."},{"key":"ref_23","doi-asserted-by":"crossref","first-page":"102","DOI":"10.1016\/j.jcrc.2021.08.012","article-title":"ROX index as a good predictor of high flow nasal cannula failure in COVID-19 patients with acute hypoxemic respiratory failure: A systematic review and meta-analysis","volume":"66","author":"Prakash","year":"2021","journal-title":"J. Crit. Care"},{"key":"ref_24","doi-asserted-by":"crossref","first-page":"288","DOI":"10.1136\/heartjnl-2013-304588","article-title":"Validity of Charlson Comorbidity Index in patients hospitalised with acute coronary syndrome. Insights from the nationwide AMIS Plus registry 2002\u20132012","volume":"100","author":"Radovanovic","year":"2014","journal-title":"Heart"},{"key":"ref_25","doi-asserted-by":"crossref","first-page":"2103","DOI":"10.1016\/j.dsx.2020.10.022","article-title":"Charlson comorbidity index and a composite of poor outcomes in COVID-19 patients: A systematic review and meta-analysis","volume":"14","author":"Henrina","year":"2020","journal-title":"Diabetes Metab. Syndr."},{"key":"ref_26","doi-asserted-by":"crossref","first-page":"1991","DOI":"10.3389\/fimmu.2020.01991","article-title":"The Impact of Pre-existing Comorbidities and Therapeutic Interventions on COVID-19","volume":"11","author":"Callender","year":"2020","journal-title":"Front. Immunol."},{"key":"ref_27","doi-asserted-by":"crossref","first-page":"47","DOI":"10.1016\/j.ijid.2020.07.029","article-title":"Comorbidities and the risk of severe or fatal outcomes associated with coronavirus disease 2019: A systematic review and meta-analysis","volume":"99","author":"Zhou","year":"2020","journal-title":"Int. J. Infect. Dis."},{"key":"ref_28","doi-asserted-by":"crossref","first-page":"1833","DOI":"10.1016\/j.jiph.2020.07.014","article-title":"COVID-19 and comorbidities: Deleterious impact on infected patients","volume":"13","author":"Ejaz","year":"2020","journal-title":"J. Infect. Public Health"},{"key":"ref_29","doi-asserted-by":"crossref","first-page":"91","DOI":"10.1016\/j.ijid.2020.03.017","article-title":"Prevalence of comorbidities and its effects in patients infected with SARS-CoV-2: A systematic review and meta-analysis","volume":"94","author":"Yang","year":"2020","journal-title":"Int. J. Infect. Dis."},{"key":"ref_30","doi-asserted-by":"crossref","unstructured":"Ssentongo, P., Ssentongo, A.E., Heilbrunn, E.S., Ba, D.M., and Chinchilli, V.M. (2020). Association of cardiovascular disease and 10 other pre-existing comorbidities with COVID-19 mortality: A systematic review and meta-analysis. PLoS ONE, 15.","DOI":"10.1371\/journal.pone.0238215"},{"key":"ref_31","doi-asserted-by":"crossref","first-page":"e03647-20","DOI":"10.1128\/mBio.03647-20","article-title":"Comorbidities in SARS-CoV-2 Patients: A Systematic Review and Meta-Analysis","volume":"12","author":"Ng","year":"2021","journal-title":"mBio"},{"key":"ref_32","doi-asserted-by":"crossref","first-page":"1119","DOI":"10.1007\/s00277-022-04813-y","article-title":"Higher ferritin levels in COVID-19 patients are associated with hyperinflammation, worse prognosis, and more bacterial infections without pronounced features of hemophagocytosis","volume":"101","author":"Lucijanic","year":"2022","journal-title":"Ann. Hematol."},{"key":"ref_33","doi-asserted-by":"crossref","unstructured":"Qeadan, F., Tingey, B., Gu, L.Y., Packard, A.H., Erdei, E., and Saeed, A.I. (2021). Prognostic Values of Serum Ferritin and D-Dimer Trajectory in Patients with COVID-19. Viruses, 13.","DOI":"10.3390\/v13030419"},{"key":"ref_34","doi-asserted-by":"crossref","first-page":"4863","DOI":"10.1038\/s41598-021-83831-8","article-title":"Ferritin is associated with the severity of lung involvement but not with worse prognosis in patients with COVID-19: Data from two Italian COVID-19 units","volume":"11","author":"Carubbi","year":"2021","journal-title":"Sci. Rep."},{"key":"ref_35","doi-asserted-by":"crossref","first-page":"mfab021","DOI":"10.1093\/mtomcs\/mfab021","article-title":"Chemistry and biology of ferritin","volume":"13","author":"Plays","year":"2021","journal-title":"Metallomics"},{"key":"ref_36","doi-asserted-by":"crossref","first-page":"102573","DOI":"10.1016\/j.autrev.2020.102573","article-title":"COVID-19 gone bad: A new character in the spectrum of the hyperferritinemic syndrome?","volume":"19","author":"Colafrancesco","year":"2020","journal-title":"Autoimmun. Rev."},{"key":"ref_37","doi-asserted-by":"crossref","first-page":"102538","DOI":"10.1016\/j.autrev.2020.102538","article-title":"Corona (COVID-19) time musings: Our involvement in COVID-19 pathogenesis, diagnosis, treatment and vaccine planning","volume":"19","author":"Shoenfeld","year":"2020","journal-title":"Autoimmun. Rev."},{"key":"ref_38","doi-asserted-by":"crossref","first-page":"762","DOI":"10.1093\/cid\/ciaa248","article-title":"Dysregulation of Immune Response in Patients with Coronavirus 2019 (COVID-19) in Wuhan, China","volume":"71","author":"Qin","year":"2020","journal-title":"Clin. Infect. Dis."},{"key":"ref_39","doi-asserted-by":"crossref","unstructured":"Rosario, C., Zandman-Goddard, G., Meyron-Holtz, E.G., D\u2019Cruz, D.P., and Shoenfeld, Y. (2013). The hyperferritinemic syndrome: Macrophage activation syndrome, Still\u2019s disease, septic shock and catastrophic antiphospholipid syndrome. BMC Med., 11.","DOI":"10.1186\/1741-7015-11-185"},{"key":"ref_40","doi-asserted-by":"crossref","first-page":"1648","DOI":"10.1002\/iid3.517","article-title":"Ferritin level: A predictor of severity and mortality in hospitalized COVID-19 patients","volume":"9","author":"Alroomi","year":"2021","journal-title":"Immun. Inflamm. Dis."},{"key":"ref_41","doi-asserted-by":"crossref","first-page":"e23618","DOI":"10.1002\/jcla.23618","article-title":"Ferritin in the coronavirus disease 2019 (COVID-19): A systematic review and meta-analysis","volume":"34","author":"Cheng","year":"2020","journal-title":"J. Clin. Lab. Anal."},{"key":"ref_42","doi-asserted-by":"crossref","first-page":"102778","DOI":"10.1016\/j.jaut.2021.102778","article-title":"Ferritin\u2014From iron, through inflammation and autoimmunity, to COVID-19","volume":"126","author":"Mahroum","year":"2022","journal-title":"J. Autoimmun."},{"key":"ref_43","doi-asserted-by":"crossref","first-page":"561","DOI":"10.1016\/j.jiph.2021.03.001","article-title":"Early prediction keys for COVID-19 cases progression: A meta-analysis","volume":"14","author":"Khodeir","year":"2021","journal-title":"J. Infect. Public Health"},{"key":"ref_44","doi-asserted-by":"crossref","first-page":"727","DOI":"10.1080\/22221751.2020.1746199","article-title":"Hypothesis for potential pathogenesis of SARS-CoV-2 infection-a review of immune changes in patients with viral pneumonia","volume":"9","author":"Lin","year":"2020","journal-title":"Emerg. Microbes Infect."},{"key":"ref_45","doi-asserted-by":"crossref","first-page":"e12967","DOI":"10.1111\/sji.12967","article-title":"Lymphopenia an important immunological abnormality in patients with COVID-19: Possible mechanisms","volume":"93","author":"Jafarzadeh","year":"2021","journal-title":"Scand. J. Immunol."},{"key":"ref_46","doi-asserted-by":"crossref","unstructured":"Guo, Z., Zhang, Z., Prajapati, M., and Li, Y. (2021). Lymphopenia Caused by Virus Infections and the Mechanisms Beyond. Viruses, 13.","DOI":"10.3390\/v13091876"},{"key":"ref_47","doi-asserted-by":"crossref","unstructured":"Niu, J., Sareli, C., Mayer, D., Visbal, A., and Sareli, A. (2022). Lymphopenia as a Predictor for Adverse Clinical Outcomes in Hospitalized Patients with COVID-19: A Single Center Retrospective Study of 4485 Cases. J. Clin. Med., 11.","DOI":"10.3390\/jcm11030700"},{"key":"ref_48","doi-asserted-by":"crossref","first-page":"1054","DOI":"10.1016\/S0140-6736(20)30566-3","article-title":"Clinical course and risk factors for mortality of adult inpatients with COVID-19 in Wuhan, China: A retrospective cohort study","volume":"395","author":"Zhou","year":"2020","journal-title":"Lancet"},{"key":"ref_49","doi-asserted-by":"crossref","first-page":"17534666211049739","DOI":"10.1177\/17534666211049739","article-title":"The predictive role of lymphocyte subsets and laboratory measurements in COVID-19 disease: A retrospective study","volume":"15","author":"Wang","year":"2021","journal-title":"Ther. Adv. Respir. Dis."}],"container-title":["Medicina"],"original-title":[],"language":"en","link":[{"URL":"https:\/\/www.mdpi.com\/1648-9144\/58\/6\/769\/pdf","content-type":"unspecified","content-version":"vor","intended-application":"similarity-checking"}],"deposited":{"date-parts":[[2025,10,10]],"date-time":"2025-10-10T23:25:04Z","timestamp":1760138704000},"score":1,"resource":{"primary":{"URL":"https:\/\/www.mdpi.com\/1648-9144\/58\/6\/769"}},"subtitle":[],"short-title":[],"issued":{"date-parts":[[2022,6,6]]},"references-count":49,"journal-issue":{"issue":"6","published-online":{"date-parts":[[2022,6]]}},"alternative-id":["medicina58060769"],"URL":"https:\/\/doi.org\/10.3390\/medicina58060769","relation":{},"ISSN":["1648-9144"],"issn-type":[{"value":"1648-9144","type":"electronic"}],"subject":[],"published":{"date-parts":[[2022,6,6]]}}}