改良ROX指数预测经鼻高流量氧疗治疗ARDS预后的价值分析

Value of modified ROX index in predicting the prognosis of acute respiratory distress syndrome treated with high-flow nasal cannula oxygen therapy

目的探讨ROX指数[血氧饱和度(SpO_(2))/氧浓度(FiO_(2))/呼吸频率(RR)]、ROX-心率(HR)指数(ROX指数/心率×100)、mROX指数[动脉血氧分压(PaO_(2))/FiO_(2)/RR]、mROX-HR指数(mROX指数/心率×100)预测经鼻高流量氧疗(HFNC)治疗急性呼吸窘迫综合征(ARDS)预后的价值。方法回顾性分析江汉大学附属湖北省第三人民医院2018年1月至2022年12月收治采用HFNC治疗的ARDS患者100例的临床资料。根据HFNC治疗是否成功分为两组:成功组65例、失败组35例。观察两组HFNC治疗2 h、12 h、24 h后ROX指数、ROX-HR指数、mROX指数、mROX-HR指数之间的差异。采用受试者工作特征曲线(ROC曲线)分析ROX指数、ROX-HR指数、mROX指数、mROX-HR指数在2 h、12 h、24 h预测HFNC治疗成败的价值,并求得截断值。结果成功组与失败组在年龄、性别、身体质量指数(BMI)、急性生理学与慢性健康状况(APACHEⅡ)评分、序贯器官衰竭(SOFA)评分、基础疾病及肺内病因占比之间比较差异均无统计学意义(均P>0.05);成功组与失败组基线HR、RR、FiO_(2)、SpO_(2)、二氧化碳分压(PaCO_(2))、PaO_(2)、pH、乳酸、氧合指数、ROX指数、mROX指数、ROX-HR指数、mROX-HR指数之间比较差异均无统计学意义(均P>0.05);成功组HFNC治疗2 h、12 h、24 h后ROX指数(6.86±1.09、6.31±1.61、8.24±2.29)均明显高于失败组(6.36±0.67、5.65±1.44、5.41±0.84),差异均有统计学意义(F=5.97、4.04、49.40,均P<0.05);成功组HFNC治疗2 h、12 h、24 h后mROX指数(5.94±1.28、5.74±1.23、8.51±2.64)均明显高于失败组(5.26±0.74、4.80±0.97、4.81±1.17),差异均有统计学意义(F=8.23、15.38、61.79,均P<0.05);成功组HFNC治疗2 h、12 h、24 h后ROX-HR指数(6.53±1.32、6.85±1.44、7.57±1.47)均明显高于失败组(5.79±1.04、5.87±1.03、5.57±0.63),差异均有统计学意义(F=8.28、12.61、58.34,均P<0.05);成功组HFNC治疗2 h、12 h、24 h后mROX-HR指数(6.11±1.30、6.86±1.13、7.79±1.79)均明显高于失败组(5.20±1.06、5.66±1.46、4.92±0.90),差异均有统计学意义(F=12.60、20.87、78.56,均P<0.05)。ROC曲线示治疗2 h后ROX指数、mROX指数、ROX-HR指数、mROX-HR指数预测HFNC成败的最佳阈值分别为6.56、6.02、6.24、5.25,曲线下面积(AUC)值分别为0.63、0.66、0.68、0.72,敏感度分别为55.4%、47.7%、56.9%、76.9%,特异度分别为71.4%、91.4%、77.1%、62.9%;12 h时最佳阈值分别为6.09、5.53、6.52、5.99,AUC值分别为0.62、0.70、0.67、0.80,敏感度分别为55.4%、53.8%、61.5%、80.0%,特异度分别为74.3%、77.1%、71.4%、74.3%;治疗24 h后最佳阈值分别为6.23、6.4、5.99、6.22,AUC值分别为0.88、0.90、0.91、0.93,敏感度分别为81.5%、80.0%、87.7%、83.1%,特异度分别为91.4%、94.3%、80.0%、91.4%。结论采用ROX指数、mROX指数、ROX-HR指数、mROX-HR指数可对ARDS患者预后进行预测,且随治疗时间延长预测价值越高,但治疗早期mROX-HR指数优势明显,可作为早期预测指标。

Objective To evaluate the value of the ROX index[blood oxygen saturation(SpO_(2))/fraction of inspiration O_(2)(FiO_(2))/respiratory rate(RR)],ROX-heart rate(HR)index(ROX index/HR×100),modified ROX(mROX)index[partial pressure of oxygen in the blood(PaO_(2))/FiO_(2)/RR],and mROX-HR index(mROX index/HR×100)in predicting prognosis for patients with acute respiratory distress syndrome(ARDS)treated with high-flow nasal cannula oxygen therapy(HFNC).Methods The clinical data of 100 patients with ARDS who received HFNC between January 2018 and December 2022 at The Third People's Hospital of Hubei Province,Jianghan University,were retrospectively analyzed.These patients were divided into two groups based on whether HFNC treatment was successful or not:a success group with 65 patients and a failure group with 35 patients.The differences in the ROX index,ROX-HR index,mROX index,and mROX-HR index in the observation group were observed at the designated time points:2,12,and 24 hours after HFNC treatment.Receiver operating characteristic(ROC)curves were utilized to evaluate the value of ROX index,ROX-HR index,mROX index,and mROX-HR index in predicting the success or failure of HFNC treatment at 2,12,and 24 hours.Cutoff values were determined.Results There were no significant differences in age,gender,body mass index,Acute Physiology and Chronic Health Evaluation(APACHE II)score,Sequential Organ Failure Assessment score,or the proportions of underlying diseases and pulmonary causes between the success and failure groups(all P>0.05).Furthermore,there were no significant differences in baseline HR,RR,FiO_(2),SpO_(2),partial pressure of carbon dioxide(PaCO_(2)),PaO_(2),pH,lactate,oxygenation index,ROX index,mROX index,ROX-HR index,or mROX-HR index between the two groups(all P>0.05).The ROX index in the success group at 2,12,and 24 hours after HFNC treatment was 6.86±1.09,6.31±1.61,and 8.24±2.29,respectively.These values were significantly higher than those in the failure group(6.36±0.67,5.65±1.44,and 5.41±0.84)at the corresponding time points(F=5.97,4.04,49.40,all P<0.05).At 2,12,and 24 hours after HFNC treatment,the mROX index in the success group was 5.94±1.28,5.74±1.23,and 8.51±2.64,respectively.These values were significantly higher than those in the failure group(5.26±0.74,4.80±0.97,4.81±1.17)at the corresponding time points(F=8.23,15.38,61.79,all P<0.05).At 2,12,and 24 hours after HFNC treatment,the ROX-HR index in the success group was 6.53±1.32,6.85±1.44,and 7.57±1.47,respectively.These values were significantly higher than those in the failure group(5.79±1.04,5.87±1.03,5.57±0.63)at the corresponding time points(F=8.28,12.61,58.34,all P<0.05).At 2,12,and 24 hours after HFNC treatment,the mROX-HR index in the success group was 6.11±1.30,6.86±1.13,and 7.79±1.79,respectively.These values were significantly higher than those in the failure group(5.20±1.06,5.66±1.46,4.92±0.90)at the corresponding time points(F=12.60,20.87,78.56,all P<0.05).The receiver operating characteristic curve analysis revealed that the optimal thresholds were 6.56,6.02,6.24,and 5.25 for the ROX index,mROX index,ROX-HR index,and mROX-HR index,respectively.The area under the curve(AUC)values were 0.63,0.66,0.68,and 0.72,with sensitivity of 55.4%,47.7%,56.9%,and 76.9%,and specificity of 71.4%,91.4%,77.1%,and 62.9%,respectively.At 12 hours after treatment,the optimal thresholds were 6.09,5.53,6.52,and 5.99,with AUC values of 0.62,0.70,0.67,and 0.80,sensitivity of 55.4%,53.8%,61.5%,and 80.0%,and specificity of 74.3%,77.1%,71.4%,and 74.3%,respectively.At 24 hours after treatment,the optimal thresholds were 6.23,6.4,5.99,and 6.22,with AUC values of 0.88,0.90,0.91,and 0.93,sensitivity of 81.5%,80.0%,87.7%,and 83.1%,and specificity of 91.4%,94.3%,80.0%,and 91.4%,respectively.Conclusion The use of the ROX index,mROX index,ROX-HR index,and mROX-HR index can aid in predicting the prognosis of ARDS patients.The predictive value of these indices increases as treatment time progresses.The mROX-HR index offers marked advantages during the initial stages of treatment and could serve as a reliable early predictor.