# ROX Index Variation as a Predictor of Outcomes in COVID-19 Patients

## TL;DR

This study shows that changes in the ROX Index over 24 hours can predict mortality and the need for mechanical ventilation in COVID-19 patients.

## Contribution

The study demonstrates that the 24-hour variation in the ROX Index is a novel and effective predictor of outcomes in COVID-19 patients.

## Key findings

- A one-unit decrease in the ROX Index difference at 24 hours increases the odds of death by 1.48.
- The ROX Index variation has an AUC of 0.92 for predicting mortality and 0.75 for predicting mechanical ventilation.
- The ROX Index is a useful tool for triaging patients in low-resource settings.

## Abstract

Background: During the COVID-19 pandemic, emergency departments were overcrowded with critically ill patients, and many providers were confronted with ethical dilemmas in assigning respiratory support to them due to scarce resources. Quick tools for evaluating patients upon admission were necessary, as many existing scores proved inaccurate in predicting outcomes. The ROX Index (RI), a rapid and straightforward scoring system reflecting respiratory status in acute respiratory failure patients, has shown promise in predicting outcomes for COVID-19 patients. The 24 h difference in the RI accurately gauges mortality and the need for invasive mechanical ventilation (IMV) among patients with COVID-19. Methods: Study design: Prospective cohort study. A total of 204 patients were admitted to the emergency department from May to August 2020. Data were collected from the clinical records. The RI was calculated at admission and 24 h later, and the difference was used to predict the association with mortality and the need for IMV, a logistic regression model was used to adjust for age, sex, presence of comorbidities, and disease severity. Finally, the data were analyzed using ROC. Results: The difference in respiratory RI between admission and 24 h is a good predictor for death (AUC 0.92) and for mechanic ventilation (AUC: 0.75). Each one-unit decrease in the RI difference at 24 h was associated with an odds ratio of 1.48 for the risk of death (95%CI: 1.31–1.67) and an odds ratio of 1.16 for IMV (95% IC: 1.1–1.23). Conclusions: The 24 h variation of RI is a good prediction tool to allow healthcare professionals to identify the patients who will benefit from invasive treatment, especially in low-resource settings.