Factors influencing the prognosis of COVID-19 patients treated with High-Flow Nasal Oxygen Therapy (HFNOT) – a retrospective analysis

Abstract

Introduction: HFNOT plays an essential role in the management of respiratory failure in COVID-19 patients. However, identifying precise prognostic factors to predict HFNOT outcomes remains crucial for optimizing patient management. Materials and methods: We made a retrospective analysis of 103 patients treated with HFNOT in Temporary Hospital nr 1 in Białystok. HFNOT failure group (58 pts; 56.3%) was defined as patients requiring treatment escalation, intubated and/or patients who died. The rest was the success group (45 pts; 43.7%). We analyzed clinical factors and laboratory tests at the beginning of HFNOT, after 2, 24, and 72 hours after the start of treatment and at the end of treatment. Statistical analysis was run in R software, version R4.1.2. Results: We found that age, arterial hypertension, heart failure, HFNOT duration days and levels of C-reactive protein, procalcitonin, number of white blood cells close to termination of the therapy, the oxygen content of the respiratory mixture (%) in 24h, heart rate in 72h, partial pressure of oxygen (mmHg) at the beginning of therapy and saturation during treatment are prognostic factors allowing to predict the effect of HFNOT therapy (p<0,05). The use of convalescent plasma, remdesivir, tocylizumab and olumiant has not been shown to improve the impact of the HFNOT used. Conclusions: Our study highlights critical prognostic factors that influence the outcomes of COVID-19 patients treated with HFNOT. Further research is needed to refine these prognostic models and to explore the potential of early invasive ventilation in patients with unfavorable prognostic indicators.