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Association of the ROX index with mortality in sepsis patients: a retrospective study

Jiali Wu1, Jing Zhao1, Xiaojing Ji2

  • 1Department of Emergency, General Hospital of Ningxia Medical University, Yinchuan, China.

Frontiers in Medicine
|December 18, 2025
PubMed
Abstract

Insights

A higher ROX index in sepsis patients is linked to reduced mortality and shorter hospital stays. This index shows moderate predictive accuracy for 28-day mortality, outperforming the SOFA score.

Area of Science:

  • Critical Care Medicine
  • Respiratory Physiology
  • Sepsis Research

Background:

  • Sepsis poses a significant global health challenge, necessitating improved prognostic tools.
  • The ROX index, a measure of respiratory function, has potential utility in assessing sepsis severity.

Purpose of the Study:

  • To investigate the association between the ROX index and clinical outcomes in sepsis patients.
  • To evaluate the predictive accuracy of the ROX index for mortality and length of stay.

Main Methods:

  • Retrospective analysis of 23,502 sepsis patients from the MIMIC-IV database.
  • Utilized restricted cubic spline and Cox regression models to assess ROX index associations.
  • Compared ROX index predictive performance against the SOFA score for 28-day mortality.

Main Results:

  • Higher ROX index strata were significantly associated with lower 28-day, 7-day, and 14-day mortality.
  • An "L"-shaped association was observed, with mortality risk plateauing around a ROX index of 10.50.
  • Optimal ROX index thresholds were identified for shortest ICU and hospital length of stay, and the ROX index demonstrated moderate predictive accuracy (AUC=0.63).

Conclusions:

  • The ROX index is a valuable tool for predicting outcomes in sepsis patients.
  • Higher ROX index values correlate with improved survival and shorter hospitalizations.
  • The ROX index offers a potentially superior alternative to the SOFA score for sepsis outcome prediction.
Keywords:
MIMIC-IVROX indexclinical outcomesmortalitysepsis

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