Predictors of Noninvasive Respiratory Support Failure in COVID-19 Patients: A Prospective Observational Study

Rolandas Zablockis; Goda Šlekytė; Rūta Mereškevičienė; Karolina Kėvelaitienė; Birutė Zablockienė; Edvardas Danila

doi:10.3390/medicina58060769

Predictors of Noninvasive Respiratory Support Failure in COVID-19 Patients: A Prospective Observational Study

Medicina (Kaunas). 2022 Jun 6;58(6):769. doi: 10.3390/medicina58060769.

Authors

Rolandas Zablockis^{1

2}, Goda Šlekytė^{1

2}, Rūta Mereškevičienė², Karolina Kėvelaitienė^{1

2}, Birutė Zablockienė^{3

4}, Edvardas Danila^{1

2}

Affiliations

¹ Clinic of Chest Diseases, Immunology and Allergology, Institute of Clinical Medicine, Vilnius University, M.K. Ciurlionio 21, 03101 Vilnius, Lithuania.
² Centre of Pulmonology and Allergology, Vilnius University Hospital Santaros Klinikos, Santariskiu St. 2, 08661 Vilnius, Lithuania.
³ Clinic of Infectious Diseases and Dermatovenerology, Institute of Clinical Medicine, Vilnius University, M.K. Ciurlionio 21, 03101 Vilnius, Lithuania.
⁴ Centre of Infectious Diseases, Vilnius University Hospital Santaros Klinikos, Santariskiu St. 2, 08661 Vilnius, Lithuania.

Abstract

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.

Keywords: COVID-19; acute hypoxemic respiratory failure; high-flow nasal cannula; non-invasive ventilation; predictive factor.

Publication types

Observational Study

MeSH terms

COVID-19* / complications
COVID-19* / therapy
Ferritins
Humans
Noninvasive Ventilation*
Respiratory Insufficiency* / etiology
Respiratory Insufficiency* / therapy
SARS-CoV-2

Substances

Ferritins

Grants and funding

This research received no external funding.