Predicting the failure on noninvasive ventilation in hypoxemic patients by updated HACOR score

Abstract

Background: Acute hypoxemic respiratory failure is a major cause of morbidity and mortality requiring ventilatory support. Non-invasive ventilation (NIV) is an alternative to invasive ventilation, and the HACOR score is widely used to predict NIV failure. The updated HACOR score incorporates additional baseline variables such as ARDS, septic shock, immunosuppression, organ failure, and SOFA score. Evidence on its predictive utility remains limited.

Methods: This prospective observational study included adult ICU patients initiated on NIV for hypoxemic respiratory failure. Baseline data included age, sex, indication for NIV, comorbidities, SOFA score, and presence of COVID-19, septic shock, and ARDS. NIV failure prediction was assessed using original and updated HACOR scores at baseline, 1–2 hours, 12 hours, and 24 hours. Diagnostic performance was compared using AUC

Results: A total of 63 patients were included. The AUC for original vs updated HACOR scores was 0.522 vs 0.404 (baseline), 0.899 vs 0.404 (1–2 hours), 0.862 vs 0.957 (12 hours), and 0.485 vs 0.500 (24 hours). Differences were statistically significant at 1–2 hours and 12 hours (p = 0.0001), but not at baseline or 24 hours.

Conclusion: The updated HACOR score, which is determined based on six baseline  variables and the five original scale items, has significantly improved predictive power for NIV failure compared to the original HACOR score at certain timeframes. This suggests time-dependent utility of both scores in predicting NIV failure.