An updated HACOR score for predicting the failure of noninvasive ventilation: a multicenter prospective observational study,Critical Care

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An updated HACOR score for predicting the failure of noninvasive ventilation: a multicenter prospective observational study
Critical Care ( IF 15.1 ) Pub Date : 2022-07-03 , DOI: 10.1186/s13054-022-04060-7
Jun Duan ₁ , Lijuan Chen ₂ , Xiaoyi Liu ₃ , Suha Bozbay ₄ , Yuliang Liu ₁ , Ke Wang ₅ , Antonio M Esquinas ₆ , Weiwei Shu _{1,

7} , Fuxun Yang ₈ , Dehua He ₉ , Qimin Chen ₉ , Bilin Wei ₁₀ , Baixu Chen ₁₁ , Liucun Li ₁₂ , Manyun Tang ₁₃ , Guodan Yuan ₁₄ , Fei Ding ₁₅ , Tao Huang ₁₆ , Zhongxing Zhang ₁₇ , ZhiJun Tang ₁₈ , Xiaoli Han ₁ , Lei Jiang ₁ , Linfu Bai ₁ , Wenhui Hu ₁ , Rui Zhang ₁ , Bushra Mina ₁₉

Affiliation

Department of Respiratory and Critical Care Medicine, The First Affiliated Hospital of Chongqing Medical University, Youyi Road 1, Yuzhong District, Chongqing, 400016, China.
Department of Respiratory and Critical Care Medicine, Sichuan Provincial People's Hospital, University of Electronic Science and Technology of China, Chengdu, China.
Department of Critical Care Medicine, Dazhou Central Hospital, Dazhou, Shichuan, China.
Intensive Care, Istanbul University Cerrahpasa-Cerrahpasa School of Medicine, Istanbul, Turkey.
Department of Respiratory and Critical Care Medicine, The Second Affiliated Hospital of Chongqing Medical University, Chongqing, China.
Intensive Care Unit, Hospital Morales Meseguer, Murcia, Spain.
Department of Critical Care Medicine, Yongchuan Hospital of Chongqing Medical University, Yongchuan, Chongqing, China.
Department of ICU, Sichuan Provincial People's Hospital, University of Electronic Science and Technology of China, Chengdu, China.
Department of Critical Care Medicine, The Affiliated Hospital of Guizhou Medical University, Guiyang, Guizhou, China.
Department of Critical Care Medicine, The First Affiliated Hospital, Sun Yat-Sen University, Guangzhou, China.
Department of Critical Care Medicine, West China Hospital of Sichuan University, Chengdu, Sichuan, China.
Department of Respiratory and Critical Care Medicine, The Second Xiangya Hospital, Central South University, Changsha, Hunan, China.
Department of Traditional Medicine and Rehabilitation, The Chest Hospital of Xi'an, Xi'an, China.
Department of Critical Care Medicine, Chonqing Public Health Medical Center, Chongqing, China.
Department of Respiratory and Critical Care Medicine, Bishan Hospital of Chongqing Medical University, Chongqing, China.
Department of Critical Care Medicine, The First Affiliated Hospital of Chongqing Medical University, Chongqing, China.
Department of Respiratory and Critical Care Medicine, Affiliated Hospital of Chongqing Three Gorges Medical College, Chongqing, China.
Department of Respiratory and Critical Care Medicine, The People's Hospital of Nanchuan, Chongqing, China.
Department of Medicine, Division of Pulmonary and Critical Care Medicine, Northwell Health, Lenox Hill Hospital, New York, NY, USA.

Heart rate, acidosis, consciousness, oxygenation, and respiratory rate (HACOR) have been used to predict noninvasive ventilation (NIV) failure. However, the HACOR score fails to consider baseline data. Here, we aimed to update the HACOR score to take into account baseline data and test its predictive power for NIV failure primarily after 1–2 h of NIV. A multicenter prospective observational study was performed in 18 hospitals in China and Turkey. Patients who received NIV because of hypoxemic respiratory failure were enrolled. In Chongqing, China, 1451 patients were enrolled in the training cohort. Outside of Chongqing, another 728 patients were enrolled in the external validation cohort. Before NIV, the presence of pneumonia, cardiogenic pulmonary edema, pulmonary ARDS, immunosuppression, or septic shock and the SOFA score were strongly associated with NIV failure. These six variables as baseline data were added to the original HACOR score. The AUCs for predicting NIV failure were 0.85 (95% CI 0.84–0.87) and 0.78 (0.75–0.81) tested with the updated HACOR score assessed after 1–2 h of NIV in the training and validation cohorts, respectively. A higher AUC was observed when it was tested with the updated HACOR score compared to the original HACOR score in the training cohort (0.85 vs. 0.80, 0.86 vs. 0.81, and 0.85 vs. 0.82 after 1–2, 12, and 24 h of NIV, respectively; all p values < 0.01). Similar results were found in the validation cohort (0.78 vs. 0.71, 0.79 vs. 0.74, and 0.81 vs. 0.76, respectively; all p values < 0.01). When 7, 10.5, and 14 points of the updated HACOR score were used as cutoff values, the probability of NIV failure was 25%, 50%, and 75%, respectively. Among patients with updated HACOR scores of ≤ 7, 7.5–10.5, 11–14, and > 14 after 1–2 h of NIV, the rate of NIV failure was 12.4%, 38.2%, 67.1%, and 83.7%, respectively. The updated HACOR score has high predictive power for NIV failure in patients with hypoxemic respiratory failure. It can be used to help in decision-making when NIV is used.

更新日期：2022-07-03

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