We retrospectively analyzed the data for 59 COVID-19 patients with AHRF in our facility to determine the cut-off value of the ROX index for respiratory therapeutic decisions and the significance of radiological evaluation of pneumonia severity. The physicians chose either HFNC or MV, and the outcomes were retrospectively analyzed using the ROX index for initiating HFNC. LIV was calculated using chest CT images at admission.
Among the 59 patients who required high-flow oxygen therapy with HFNC at admission, 24 were later transitioned to MV; the remaining 35 patients recovered. Four of the 24 patients in the MV group died, and the ROX index values of these patients were 9.8, 7.3, 5.4, and 3.0, respectively. These index values indicated that the ROX index of half of the patients who died was higher than the reported cut-off values of the ROX index, which range from 2.7-5.99. The cut-off value of the ROX index 6 hours after the start of HFNC, which was used to classify the management of HFNC or MV as a physician\'s clinical decision, was approximately 6.1. The LIV cut-off value on chest CT between HFNC and MV was 35.5%. Using both the ROX index and LIV, the cut-off classifying HFNC or MV was obtained using the equation, LIV = 4.26 × (ROX index) + 7.89. The area under the receiver operating characteristic curve, as an evaluation metric of the classification, improved to 0.94 with a sensitivity of 0.79 and specificity of 0.91 using both the ROX index and LIV.
Physicians\' empirical decisions associated with the choice of respiratory therapy for HFNC oxygen therapy or MV can be supported by the combination of the ROX index and the LIV index calculated from chest CT images.
■我们回顾性分析了在我们设施中59例AHRFCOVID-19患者的数据,以确定ROX指数对呼吸系统治疗决策的临界值以及放射学评估肺炎严重程度的意义。医生选择了HFNC或MV,结果采用ROX指数对开始HFNC进行回顾性分析.入院时使用胸部CT图像计算LIV。
■在入院时需要使用HFNC进行高流量氧气治疗的59例患者中,24例后来过渡到MV;其余35例患者康复。MV组24例患者中有4例死亡,这些患者的ROX指数值分别为9.8,7.3,5.4和3.0.这些指标值表明,一半死亡患者的ROX指数高于报告的ROX指数的临界值,范围在2.7-5.99之间。HFNC开始后6小时的ROX指数的截止值,用于将HFNC或MV的管理分类为医师的临床决策,大约是6.1。HFNC和MV在胸部CT上的LIV临界值为35.5%。使用ROX指数和LIV,使用方程获得了对HFNC或MV的截止分类,LIV=4.26×(ROX指数)+7.89。接收器工作特性曲线下的面积,作为分类的评估指标,使用ROX指数和LIV均可提高至0.94,敏感性为0.79,特异性为0.91.
■医师选择HFNC氧疗或MV的呼吸治疗相关的经验决策可以通过从胸部CT图像计算的ROX指数和LIV指数的组合来支持。