ACMJ
Anatolian Current Medical Journal

Anatolian Current Medical Journal (ACMJ) is an unbiased, peer-reviewed, and open access international medical journal. The Journal publishes interesting clinical and experimental research conducted in all fields of medicine, interesting case reports, and clinical images, invited reviews, editorials, letters, comments, and related knowledge.

eISSN: 2718-0115
Creative Commons CC BY-NC-ND 4.0 International License.
EndNote Style

Submit Manuscript

Index
Original Article
Assessment of the ROX index as a predictor of invasive ventilation in patients with community-acquired pneumonia
Abstract
Aims: Community-acquired pneumonia (CAP) is a significant cause of morbidity and mortality worldwide, particularly among elderly patients and those with comorbid conditions. CAP can lead to severe respiratory failure, often necessitating invasive mechanical ventilation (IMV). Early identification of patients at high risk for intubation is crucial for optimizing management and improving outcomes. The ROX index, which incorporates respiratory rate, oxygen saturation, and fraction of inspired oxygen, has emerged as a potential tool for predicting the need for IMV in patients with respiratory distress. This study aims to evaluate the effectiveness of the ROX index in predicting IMV in patients hospitalized with CAP.
Methods: This retrospective cohort study included patients diagnosed with CAP who were admitted to a tertiary healthcare institution between January 1, 2019, and January 1, 2024. The ROX index was calculated at hospital admission using respiratory rate, oxygen saturation (SpO²), and fraction of inspired oxygen (FiO²). Severe pneumonia was defined as pneumonia severity index (PSI) class IV or V, and subgroup analyses were conducted for these patients to evaluate the diagnostic performance of the ROX index. The primary outcome was the requirement for IMV, and the predictive ability of the ROX index was evaluated.
Results: A total of 416 patients were included, with 30 (7.2%) requiring invasive mechanical ventilation. The mean ROX index was significantly lower in the intubation group (14.4±4.5) compared to the non-intubation group (23.8±5.4) (p<0.001). A ROX index ?18.7 was identified as the optimal cutoff for predicting IMV, with an AUROC of 0.908. Among patients with severe pneumonia, the ROX index demonstrated an AUROC of 0.831, indicating strong predictive performance in this subgroup.
Conclusion: The ROX index is a valuable tool for predicting the need for invasive mechanical ventilation in patients with CAP, particularly in those with severe pneumonia, making it a useful tool for early risk stratification and clinical decision-making.

Keywords : Critical care, mechanical ventilation, pneumonia

Download Article


1. Eshwara VK, Mukhopadhyay C, Rello J. Community-acquired bacterial pneumonia in adults: an update. Indian J Med Res. 2020;151(4):287-302.
2. Nair GB, Niederman MS. Updates on community acquired pneumonia management in the ICU. Pharmacol Ther. 2021;217:107663.
3. Rothberg MB. Community-acquired pneumonia. Ann Intern Med. 2022; 175(4):ITC49-ITC64.
4. Heo JY, Song JY. Disease burden and etiologic distribution of community-acquired pneumonia in adults: evolving epidemiology in the era of pneumococcal conjugate vaccines. Infect Chemother. 2018;50(4): 287-300.
5. Modi AR, Kovacs CS. Community-acquired pneumonia: strategies for triage and treatment. Cleve Clin J Med. 2020;87(3):145-151.
6. Vaughn VM, Dickson RP, Horowitz JK, Flanders SA. Community-acquired pneumonia: a review. JAMA. 2024;332(15):1282-1295.
7. Martin-Loeches I, Torres A, Nagavci B, et al. Correction: ERS/ESICM/ESCMID/ALAT guidelines for the management of severe community-acquired pneumonia.Intensive Care Med. 2023;49(8):1040-1041.
8. Niederman MS, Torres A. Severe community-acquired pneumonia. Eur Respir Rev. 2022;31(166):220123.
9. Roca O, Messika J, Caralt B, et al. Predicting success of high-flow nasal cannula in pneumonia patients with hypoxemic respiratory failure: the utility of the ROX index. J Crit Care. 2016;35:200-205.
10. Gallardo A, Zamarr&oacute;n-L&oacute;pez E, Deloya-Tomas E, P&eacute;rez-Nieto OR. Advantages and limitations of the ROX index. Pulmonology. 2022;28(4): 320-321.
11. Praphruetkit N, Boonchana N, Monsomboon A, Ruangsomboon O. ROX index versus HACOR scale in predicting success and failure of high-flow nasal cannula in the emergency department for patients with acute hypoxemic respiratory failure: a prospective observational study. Int J Emerg Med. 2023;16(1):3.
12. Ferreira-Coimbra J, Sarda C, Rello J. Burden of community-acquired pneumonia and unmet clinical needs. Adv Ther. 2020;37(4):1302-1318.
13. DeLaney M, Khoury C. Community-acquired pneumonia in the emergency department. Emerg Med Pract. 2021;23(2):1-24.
14. Olson G, Davis AM. Diagnosis and treatment of adults with community-acquired pneumonia. JAMA. 2020;323(9):885-886.
15. Yau CE, Lee DYX, Vasudevan A, et al. Performance of the ROX index in predicting high flow nasal cannula failure in COVID-19 patients: a systematic review and meta-analysis. Crit Care. 2023;27(1):320.
16. Hancı P, Uysal A, Y&uuml;ksel B, İnal V. Rox index dynamics according to high flow nasal cannula success in intensive care unit patients with COVID-19-related acute respiratory failure. Balkan Med J. 2023;40(2):111-116.
17. Colaianni-Alfonso N, Montiel GC, Castro-Sayat M, Roca O, Grieco DL. ROX index to predict CPAP outcome in hypoxemic respiratory failure due to COVID-19. Intensive Care Med. 2022;48(12):1818-1819.
18. Zaboli A, Ausserhofer D, Pfeifer N, et al. The ROX index can be a useful tool for the triage evaluation of COVID-19 patients with dyspnoea. J Adv Nurs. 2021;77(8):3361-3369.
19. Reyes LF, Bastidas Goyes A, Tuta Quintero EA, et al. Validity of the ROX index in predicting invasive mechanical ventilation requirement in pneumonia. BMJ Open Respir Res. 2022;9(1):e001320.
20. Suliman LA, Abdelgawad TT, Farrag NS, Abdelwahab HW. Validity of ROX index in prediction of risk of intubation in patients with COVID-19 pneumonia. Adv Respir Med. 2021;89(1):1-7.
Article available in :
Volume 7, Issue 1, 2025
Page : 37-42
https://doi.org/10.38053/acmj.1583232
Article Information
Received : 11 Kas 2024
Accepted : 13 Ara 2024
Published : 10 Oca 2025
Corresponding Author :

Ömerul Faruk Aydın: Department of Emergency Medicine, Faculty of Medicine, İstanbul Yeni Yüzyıl University, İstanbul, Turkiye

[email protected]
Citation : Aydın ÖF, Tatlıparmak AC. Assessment of the ROX index as a predictor of invasive ventilation in patients with community-acquired pneumonia. Anatolian Curr Med J. 2025;7(1):37-42.

Read: -7
Cited: 0
Download : 23
_Footer