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Meta-Analysis
. 2021 Dec:66:102-108.
doi: 10.1016/j.jcrc.2021.08.012. Epub 2021 Sep 8.

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

Jay Prakash  1 , Pradip Kumar Bhattacharya  2 , Arun Kumar Yadav  3 , Amit Kumar  4 , Lal Chand Tudu  2 , Kameshwar Prasad  5
Affiliations
Meta-Analysis

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

Jay Prakash et al. J Crit Care. 2021 Dec.

Abstract

Purpose: Prediction of high flow nasal cannula (HFNC) failure in COVID-19 patients with acute hypoxemic respiratory failure (AHRF) may improve clinical management and stratification of patients for optimal treatment. We performed a systematic review and meta-analysis to determine performance of ROX index as a predictor of HFNC failure.

Materials and methods: Systematic search was performed in electronic databases (PubMed, Google Scholar, Web of Science and Cochrane Library) for articles published till 15 June 2021 investigating ROX index as a predictor for HFNC failure. Quality In Prognosis Studies (QUIPS) tool was used to analyze risk of bias for prognostic factors, by two independent authors.

Results: Eight retrospective or prospective cohort studies involving 1301 patients showed a good discriminatory value, summary area under the curve (sAUC) 0.81 (95% CI, 0.77-0.84) with sensitivity of 0.70 (95% CI, 0.59-0.80) and specificity of 0.79 (95% CI, 0.67-0.88) for predicting HNFC failure. The positive and negative likelihood ratio were 3.0 (95% CI, 2.2-5.3) and 0.37 (95% CI, 0.28-0.50) respectively, and was strongly associated with a promising predictive accuracy (Diagnostic odds ratio (DOR) 9, 95% CI, 5-16).

Conclusion: This meta-analysis suggests ROX index has good discriminating power for prediction of HFNC failure in COVID-19 patients with AHRF.

Keywords: Acute hypoxemic respiratory failure; COVID-19; High flow nasal cannula; ROX index.

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Figures

Fig. 1
Fig. 1
PRISMA flow diagram.
Fig. 2
Fig. 2
Risk of bias summary.
Fig. 3
Fig. 3
Summary receiver operating characteristic graph for the included studies. The AUC of ROX-index for probability in predicting HNFC failure was 0.81 (95% CI, 0.77–0.84).
Fig. 4
Fig. 4
Forest plot of the sensitivity and specificity of ROX-index for predicting HNFC failure in patients with COVID-19. The pooled sensitivity and specificity were 0.70 (95% CI, 0.59–0.80) and 0.79 (95% CI, 0.67–0.88), respectively.
Fig. 5
Fig. 5
Fagan nomogram showing pre-test probability and post-test probability using ROX index for predicting HNFC failure.
Fig. 6
Fig. 6
Deek funnel plot showing publication bias for studies included in the meta-analysis.
Fig. 7
Fig. 7
Forest plot showing pooled sensitivity and pooled specificity of clinical variables for predicting HNFC Failure.
See this image and copyright information in PMC

References

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