Stratifying risk outcomes among adult COVID-19 inpatients with high flow oxygen: The R4 score Academic Article in Scopus uri icon

abstract

  • © 2021 Sociedade Portuguesa de PneumologiaBackground: High flow oxygen therapy (HFO) is a widely used intervention for pulmonary complications. Amid the coronavirus infectious disease 2019 (COVID-19) pandemic, HFO became a popular alternative to conventional oxygen supplementation therapies. Risk stratification tools have been repurposed ¿and new ones developed¿ to estimate outcome risks among COVID-19 patients. This study aims to provide a simple risk stratification system to predict invasive mechanical ventilation (IMV) or death among COVID-19 inpatients on HFO. Methods: Among 529 adult inpatients with COVID-19 pneumonia, we selected unadjusted clinical risk factors for developing the composite endpoint of IMV or death. The risk for the primary outcome by each category was estimated using a Cox proportional hazards model. Bootstrapping was used to validate the results. Results: Age above 62, eGFR under 60 ml/min, room air SpO2 ¿89 % upon admission, history of hypertension, history of diabetes, and any comorbidity (cancer, cardiovascular disease, COPD/ asthma, hypothyroidism, or autoimmune disease) were considered for the score. Each of the six criteria scored 1 point. The score was further simplified into 4 categories: 1) 0 criteria, 2) 1 criterion, 3) 2-3 criteria, and 4) ¿4 criteria. Taking the first category as the reference, risk estimates for the primary endpoint were HR; 2.94 [1.67 ¿ 5.26], 4.08 [2.63 ¿ 7.05], and 6.63 [3.74 ¿ 11.77], respectively. In ROC analysis, the AUC for the model was 0.72. Conclusions: Our score uses simple criteria to estimate the risk for IMV or death among COVID-19 inpatients with HFO. Higher category reflects consistent increases in risk for the endpoint.

publication date

  • May 1, 2023