Background: The main concern when treating COVID-19 acute respiratory distress syndrome (ARDS) during high flow nasal cannula (HFNC) is delayed intubation, thus increasing the risk of prior mortality. This study aims to analyze the prognostic ability of the Respiratory Rate Oxygenation (ROX) index as a predictor for intubation and 28-days mortality in COVID-19 patients. Methods: A retrospective analysis of COVID-19 patients admitted to Intensive Care Unit (ICU) Dr. Soetomo General Hospital in Surabaya from July to December 2020 with ARDS. The ROX indices were recorded at the 1st hour, 2nd, 4th, 6th, 12th, 18th, 24th, and 48th hours of treatment in ICU with HFNC. Identification of ROX association with HFNC failure led to intubation and 28-days mortality was through Cox proportional hazards regression. The most specific cut-off of the ROX index for predicting intubation and 28-days mortality was assessed. Result: Among 78 patients who met the inclusion criteria, 26 (33.3%) patients required intubation. Out of 26 patients, six patients were extubated and had survived. The 28-days mortality rate is 20 (25.6%) patients. The ROX index at 12th hours (ROX-12) ≤ 4.85 (AUC 0.857; p<0.001; HR 4.7) and the ROX index at 48th hours (ROX-48) ≤ 5.68 (AUC 0.858; p<0.001; HR 5.4) can accurately predict the need for intubation. ROX-12 ≤ 4.745 is a predictor of 28-days mortality (AUC 0.85, p<0.001; HR 10.2). Conclusion: ROX index predicts the risk of intubation and 28-days mortality especially ROX-12 and ROX-48. Utilization of ROX index for rapid assessment of the respiratory deterioration in COVID-19 is recommended.

Background: Geriatric, obesity, and chronic disease are classified as risk factors for adverse outcomes of coronavirus disease 2019 (COVID-19). Studies regarding the importance of these comorbidities in COVID-19 with severe complications such as acute respiratory distress syndrome (ARDS) are scarce. This study aims to analyze age, obesity, and chronic disease comorbidities as risk factors for 28-days mortality in COVID-19 patients with ARDS. Methods: A retrospective, single-center study was conducted in Dr. Soetomo General Hospital, Surabaya, Indonesia between July-October 2020. We included all adult inpatients (≥18 years old) of confirmed COVID-19 with ARDS. Demographic, comorbidities, initial PaO2/FiO2 ratio, time of discharge or death were obtained from medical records and compared the ARDS severity between survivors and non-survivors. The univariate and multivariate logistic regression methods were used to identify risk factors associated with in-hospital death. Result: Among 102 patients of COVID-19 with ARDS, the median age is 52 years. Most of them are within 50 – 59 age categories. The median hospital length of stay (LOS) for survivor is 22 (15.7 – 26) days and 9 (4.25 – 14.4) days for non-survivor. The 28-days mortality rate is 48 (47.1%) patients. Age > 65 years old (HR= 2.7, 95% CI 1.39 – 5.44, p value= 0.004), obesity (HR= 2.2, 95% CI 1.16 – 4.51, p value= 0.016), and chronic hypertension (HR= 1.98, 95% CI 1.11 – 3.52, p value= 0.02) are the independent risk factors for 28-days mortality in COVID-19 with ARDS. Conclusion: Geriatric, obesity, and chronic hypertension comorbidities are the risk factors for mortality of COVID-19 with ARDS complications.