Observational studyPloS one2022
Expanding the utility of the ROX index among patients with acute hypoxemic respiratory failure.
Observational study in PloS one, 2022. The graph could read no effect estimate from its abstract, so it casts no vote on the map. An erratum has been issued. Cited by 6 papers.
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The abstract states no effect estimate the extractor could read, or names no intervention and outcome on the map, so this paper lights no cell and moves no belief. It is still indexed, cited and linked below.
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Who cites it
6 citing papers in PubMed, 10 citations in OpenAlex.
- Prognostic significance of the ROX index in patients with acute exacerbation of interstitial lung disease treated with high-flow nasal cannula oxygen therapy: a retrospective cohort study.BMC pulmonary medicine · 2026Article
- Prediction of high-flow nasal cannula failure in critically ill patients: a narrative review.Journal of intensive care · 2026Review
- Comparisons of mortality predictions of mROX, CURB-65, and APACHE II in patients with severe pneumonia: A retrospective cohort study.Medicine · 2025Article
- Association of the ROX index with mortality in sepsis patients: a retrospective study.Frontiers in medicine · 2025Article
- Correction: Expanding the utility of the ROX index among patients with acute hypoxemic respiratory failure.PloS one · 2023Article
- ROX index: An important predictor of high-flow nasal cannula and non-invasive ventilation failure.Lung India : official organ of Indian Chest SocietyArticle
Corrections and comments
- Erratum issued
Authors and funding
22 authors at 7 institutions in 1 country.
Funding
No grant is acknowledged in the PubMed record.
Abstract
backgroundDelaying intubation in patients who fail high-flow nasal cannula (HFNC) may result in increased mortality. The ROX index has been validated to predict HFNC failure among pneumonia patients with acute hypoxemic respiratory failure (AHRF), but little information is available for non-pneumonia causes. In this study, we validate the ROX index among AHRF patients due to both pneumonia or non-pneumonia causes, focusing on early prediction.
methodsThis was a retrospective observational study in eight Singapore intensive care units from 1 January 2015 to 30 September 2017. All patients >18 years who were treated with HFNC for AHRF were eligible and recruited. Clinical parameters and arterial blood gas values at HFNC initiation and one hour were recorded. HFNC failure was defined as requiring intubation post-HFNC initiation.
resultsHFNC was used in 483 patients with 185 (38.3%) failing HFNC. Among pneumonia patients, the ROX index was most discriminatory in pneumonia patients one hour after HFNC initiation [AUC 0.71 (95% CI 0.64-0.79)], with a threshold value of <6.06 at one hour predicting HFNC failure (sensitivity 51%, specificity 80%, positive predictive value 61%, negative predictive value 73%). The discriminatory power remained moderate among pneumonia patients upon HFNC initiation [AUC 0.65 (95% CI 0.57-0.72)], non-pneumonia patients at HFNC initiation [AUC 0.62 (95% CI 0.55-0.69)] and one hour later [AUC 0.63 (95% CI 0.56-0.70)].
conclusionThe ROX index demonstrated moderate discriminatory power among patients with either pneumonia or non-pneumonia-related AHRF at HFNC initiation and one hour later.
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