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

Critical Care

Guodan Yuan¹  Xiaoyi Liu²  Qimin Chen³  Dehua He³  Tao Huang⁴  Bilin Wei⁵  Baixu Chen⁶  Fuxun Yang⁷  Bushra Mina⁸  Zhongxing Zhang⁹  Fei Ding^1,10  Lijuan Chen^1,11  Yuliang Liu^1,12  Linfu Bai^1,12  Weiwei Shu^1,12  Xiaoli Han^1,12  Wenhui Hu^1,12  Jun Duan^1,12  Rui Zhang^1,12  Lei Jiang^1,12  ZhiJun Tang^1,13  Ke Wang^1,14  Liucun Li^1,15  Manyun Tang^1,16  Antonio M. Esquinas^1,17  Suha Bozbay^1,18 

[1] Department of Critical Care Medicine, Chonqing Public Health Medical Center;Department of Critical Care Medicine, Dazhou Central Hospital;Department of Critical Care Medicine, The Affiliated Hospital of Guizhou Medical University;Department of Critical Care Medicine, The First Affiliated Hospital of Chongqing Medical University;Department of Critical Care Medicine, The First Affiliated Hospital, Sun Yat-Sen University;Department of Critical Care Medicine, West China Hospital of Sichuan University;Department of ICU, Sichuan Provincial People’s Hospital, University of Electronic Science and Technology of China;Department of Medicine, Division of Pulmonary and Critical Care Medicine, Northwell Health, Lenox Hill Hospital;Department of Respiratory and Critical Care Medicine, Affiliated Hospital of Chongqing Three Gorges Medical College;Department of Respiratory and Critical Care Medicine, Bishan Hospital of Chongqing Medical University;Department of Respiratory and Critical Care Medicine, Sichuan Provincial People’s Hospital, University of Electronic Science and Technology of China;Department of Respiratory and Critical Care Medicine, The First Affiliated Hospital of Chongqing Medical University;Department of Respiratory and Critical Care Medicine, The People’s Hospital of Nanchuan;Department of Respiratory and Critical Care Medicine, The Second Affiliated Hospital of Chongqing Medical University;Department of Respiratory and Critical Care Medicine, The Second Xiangya Hospital, Central South University;Department of Traditional Medicine and Rehabilitation, The Chest Hospital of Xi’an;Intensive Care Unit, Hospital Morales Meseguer;Intensive Care, Istanbul University Cerrahpasa-Cerrahpasa School of Medicine;

关键词: Noninvasive ventilation;    Acute respiratory failure;    Scoring system;   

DOI  :  10.1186/s13054-022-04060-7

来源: DOAJ

【 摘 要 】

Abstract Background 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. Methods 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. Results 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. Conclusions 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.

【 授权许可】

Unknown