ArticleRespiratory care2024
Using the ROX Index to Predict Treatment Outcome for High-Flow Nasal Cannula and/or Noninvasive Ventilation in Patients With COPD Exacerbations.
Article in Respiratory care, 2024. The graph could read no effect estimate from its abstract, so it casts no vote on the map. Cited by 5 papers, 1 of them a synthesis that pooled it.
What it found
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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.
The trial behind it
Trials whose registry record cites this paper, or whose number appears in the abstract. A trial that started after this paper was published is citing it as background, not reporting it.
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Who cites it
5 citing papers in PubMed, 1 synthesis or guideline pooled it, 4 citations in OpenAlex.
- Machine learning-based prediction models for noninvasive respiratory support failure in acute respiratory failure: a systematic review and meta-analysis.Frontiers in medicine · 2026Pooled it
- [Invasive mechanical ventilation: indications and alternatives : Systematic evaluation of the evidence and recommendations for clinical practice from the S3 guidelines "invasive mechanical ventilation and the use of extracorporeal procedures in acute respiratory failure"].Medizinische Klinik, Intensivmedizin und Notfallmedizin · 2026Review
- Prediction of high-flow nasal cannula failure in critically ill patients: a narrative review.Journal of intensive care · 2026Review
- Prognostic Value of the ROX Index for Mortality in Chronic Obstructive Pulmonary Disease: A Retrospective Cohort Study Using the MIMIC-IV Database.International journal of chronic obstructive pulmonary disease · 2026Article
- Non-Invasive Ventilation: When, Where, How to Start, and How to Stop.Journal of clinical medicine · 2025Review
Corrections and comments
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Authors and funding
10 authors at 3 institutions in 1 country.
Funding
Abstract
backgroundThe ratio of oxygen saturation index (ROX index; or S
methodsWe performed a retrospective study of 260 adults hospitalized with a COPD exacerbation and treated with HFNC and/or NIV (continuous or bi-level). ROX index scores were collected at treatment initiation and predefined time intervals throughout HFNC and/or NIV treatment or until the subject was intubated or died. A ROX index score of ≥ 4.88 was applied to the cohort to determine if the same score would perform similarly in this different cohort. Accuracy of the ROX index was determined by calculating the area under the receiver operator curve.
resultsA total of 47 subjects (18%) required invasive mechanical ventilation or died while on HFNC/NIV. The ROX index at treatment initiation, 1 h, and 6 h demonstrated the best prediction accuracy for avoidance of invasive mechanical ventilation or death (area under the receiver operator curve 0.73 [95% CI 0.66-0.80], 0.72 [95% CI 0.65-0.79], and 0.72 [95% CI 0.63-0.82], respectively). The optimal cutoff value for sensitivity (Sn) and specificity (Sp) was a ROX index score > 6.88 (sensitivity 62%, specificity 57%).
conclusionsThe ROX index applied to adults with COPD exacerbations treated with HFNC and/or NIV required higher scores to achieve similar prediction of low risk of treatment failure when compared to subjects with hypoxemic respiratory failure/pneumonia. ROX scores < 4.88 did not accurately predict intubation or death.
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