Comparison of the Discrimination Capacity of the ROX and HACOR Scales to Predict High-flow Nasal Cannula Failure in Patients With SARS-CoV-2 Pneumonia

Abstract

BackgroundThe pandemic of SARSCov2 infection has created a challenge in health services worldwide. Some scales have been applied to evaluate the risk of intubation, such as the ROX and HACOR. The objective of this study is to compare the predictive capacity of the HACOR scale and the ROX index and define the optimal cut-off points.MethodsStudy of diagnostic tests based on a retrospective cohort. Composite outcome was the proportion of patients that needed orotracheal intubation or died of COVID19 pneumonia. Discrimination capacity was compared by the area under the curve of each of the two scales and the optimal cut-off point was determined using the Liu method.Results245 patients were included, of which 140 (57.14%) required OTI and 152 (62.04%) had the composite end result of HFNC failure. The discrimination capacity was similar for the two scales with an AUROC of 0.71 and 0.72 for the HACOR scale for the ROX index, respectively. The optimal cut-off point for the ROX index was 5.62 (sensitivity 62% specificity 65%), while the optimal cut-off point for the HACOR scale was 5.5 (sensitivity 66% specificity 65%).ConclusionsThe HACOR scale and the ROX index have a moderate predictive capacity to predict failures to the HFNC strategy. They can be used in conjunction with other clinical variables to define which patients may require invasive mechanical ventilation.