A Novel Risk-Stratification Models of the High-Flow Nasal Cannula Therapy in COVID-19 Patients With Hypoxemic Respiratory Failure.
A Novel Risk-Stratification Models of the High-Flow Nasal Cannula Therapy in COVID-19 Patients With Hypoxemic Respiratory Failure.
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DOI：
10.3389/fmed.2020.607821
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发表时间：
2020
影响因子：
3.9
通讯作者：
Shang Y
中科院分区：
文献类型：
--
作者：
Xu J;Yang X;Huang C;Zou X;Zhou T;Pan S;Yang L;Wu Y;Ouyang Y;Wang Y;Xu D;Zhao X;Shu H;Jiang Y;Xiong W;Ren L;Liu H;Yuan Y;Qi H;Fu S;Chen D;Zhang D;Yuan S;Shang Y
背景资料：高流量鼻插管（HFNC）已被推荐为2019冠状病毒病（COVID-19）患者在机械通气（MV）前管理急性低氧性呼吸衰竭的合适选择;然而，在持续的大流行期间，使用HFNC治疗延迟MV仍然是该技术和临床管理之间的两难选择。方法：回顾性分析中国武汉市四家医院接受HFNC治疗的COVID-19患者。收集并分析HFNC开始前、开始时和开始后不久的人口统计学信息和临床变量。以金银潭医院324例HFNC患者为研究对象，建立HFNC失败（需要MV）的风险分层模型，并以69例其他医院的HFNC患者为研究对象，验证其准确性。结果如下：在训练队列中，HFNC治疗的中位持续时间为6（范围，3-11），147例在HFNC开始后7天内发生HFNC失败。多变量回归分析显示HFNC失败的早期预测因素包括年龄大于60岁[比值比（OR），1.93; 95%可信区间（CI），1.08-3.44; p = 0.027; 2分]，呼吸频率-氧合指数（ROX）<5.31（OR，5.22; 95%CI，2.96-9.20; p < 0.001; 5分）在HFNC开始的前4小时内，血小板< 125 × 109/L在HFNC开始时，IL-6> 7.0 pg/mL（OR，3.04; 95%CI，1.46-6.35; p = 0.003; 3分）和白细胞介素6（IL-6）>7.0 pg/mL（OR，3.34; 95%CI，1.79-6.23; p < 0.001; 3分）。这些预测因子的加权风险分层模型显示敏感性为80.3%，特异性为71.2%，并且比单独的ROX指数具有更好的预测能力[曲线下面积（AUC）= 0.807 vs. 0.779，p < 0.001]。6分被用作HFNC失败分层风险的临界值。低危组HFNC成功率（84.2%）是高危组（34.8%）的9.84倍。在随后的验证队列中，模型的AUC为0.815（0.71-0.92）。结论：ROX指数较低、血小板减少和IL-6值升高的老年患者HFNC失败的风险增加。风险分层模型准确预测了HFNC失败，并将接受HFNC治疗的COVID-19患者早期分层为相关风险类别。
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.
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影响因子：
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DOI：
10.1016/s0262-4079(20)30663-1
发表时间：
2020-04-04
期刊：
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影响因子：
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