A Novel Risk-Stratification Models of the High-Flow Nasal Cannula Therapy in COVID-19 Patients With Hypoxemic Respiratory Failure.

Abstract

Background: High-flow nasal cannula (HFNC) has been recommended as a suitable choice for the management of coronavirus disease 2019 (COVID-19) patients with acute hypoxemic respiratory failure before mechanical ventilation (MV); however, delaying MV with HFNC therapy is still a dilemma between the technique and clinical management during the ongoing pandemic. Methods: Retrospective analysis of COVID-19 patients treated with HFNC therapy from four hospitals of Wuhan, China. Demographic information and clinical variables before, at, and shortly after HFNC initiation were collected and analyzed. A risk-stratification model of HFNC failure (the need for MV) was developed with the 324 patients of Jin Yin-tan Hospital and validated its accuracy with 69 patients of other hospitals. Results: Among the training cohort, the median duration of HFNC therapy was 6 (range, 3-11), and 147 experienced HFNC failure within 7 days of HFNC initiation. Early predictors of HFNC failure on the basis of a multivariate regression analysis included age older than 60 years [odds ratio (OR), 1.93; 95% confidence interval (CI), 1.08-3.44; p = 0.027; 2 points], respiratory rate-oxygenation index (ROX) <5.31 (OR, 5.22; 95% CI, 2.96-9.20; p < 0.001; 5 points) within the first 4 h of HFNC initiation, platelets < 125 × 109/L (OR, 3.04; 95% CI, 1.46-6.35; p = 0.003; 3 points), and interleukin 6 (IL-6) >7.0 pg/mL (OR, 3.34; 95% CI, 1.79-6.23; p < 0.001; 3 points) at HFNC initiation. A weighted risk-stratification model of these predictors showed sensitivity of 80.3%, specificity of 71.2% and a better predictive ability than ROX index alone [area under the curve (AUC) = 0.807 vs. 0.779, p < 0.001]. Six points were used as a cutoff value for the risk of HFNC failure stratification. The HFNC success probability of patients in low-risk group (84.2%) was 9.84 times that in the high-risk group (34.8%). In the subsequent validation cohort, the AUC of the model was 0.815 (0.71-0.92). Conclusions: Aged patients with lower ROX index, thrombocytopenia, and elevated IL-6 values are at increased risk of HFNC failure. The risk-stratification models accurately predicted the HFNC failure and early stratified COVID-19 patients with HFNC therapy into relevant risk categories.

• Authors: Jiqian Xu, Xiaobo Yang, Chaolin Huang, Xiaojing Zou, Ting Zhou, Shangwen Pan, Luyu Yang, Yongran Wu, Yaqi Ouyang, Yaxin Wang, Dan Xu, Xin Zhao, Huaqing Shu, Yongxiang Jiang, Wei Xiong, Lehao Ren, Hong Liu, Yin Yuan, Hong Qi, Shouzhi Fu, Dechang Chen, Dingyu Zhang, Shiying Yuan, You Shang
• Journal: Frontiers in medicine (Front Med (Lausanne)) Vol. 7 Pg. 607821 ( 2020) ISSN: 2296-858X [Print] Switzerland
• PMID: 33425951 (Publication Type: Journal Article)
• Copyright: Copyright © 2020 Xu, Yang, Huang, Zou, Zhou, Pan, Yang, Wu, Ouyang, Wang, Xu, Zhao, Shu, Jiang, Xiong, Ren, Liu, Yuan, Qi, Fu, Chen, Zhang, Yuan and Shang.