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

作者全名："Duan, Jun; Chen, Lijuan; Liu, Xiaoyi; Bozbay, Suha; Liu, Yuliang; Wang, Ke; Esquinas, Antonio M.; Shu, Weiwei; Yang, Fuxun; He, Dehua; Chen, Qimin; Wei, Bilin; Chen, Baixu; Li, Liucun; Tang, Manyun; Yuan, Guodan; Ding, Fei; Huang, Tao; Zhang, Zhongxing; Tang, ZhiJun; Han, Xiaoli; Jiang, Lei; Bai, Linfu; Hu, Wenhui; Zhang, Rui; Mina, Bushra"

作者地址："[Duan, Jun; Liu, Yuliang; Shu, Weiwei; Han, Xiaoli; Jiang, Lei; Bai, Linfu; Hu, Wenhui; Zhang, Rui] Chongqing Med Univ, Affiliated Hosp 1, Dept Resp & Crit Care Med, Youyi Rd 1, Chongqing 400016, Peoples R China; [Chen, Lijuan] Univ Elect Sci & Technol China, Sichuan Prov Peoples Hosp, Dept Resp & Crit Care Med, Chengdu, Peoples R China; [Liu, Xiaoyi] Dazhou Cent Hosp, Dept Crit Care Med, Dazhou, Shichuan, Peoples R China; [Bozbay, Suha] Istanbul Univ Cerrahpasa, Cerrahpasa Sch Med, Intens Care, Istanbul, Turkey; [Wang, Ke] Chongqing Med Univ, Affiliated Hosp 2, Dept Resp & Crit Care Med, Chongqing, Peoples R China; [Esquinas, Antonio M.] Hosp Morales Meseguer, Intens Care Unit, Murcia, Spain; [Shu, Weiwei] Chongqing Med Univ, Yongchuan Hosp, Dept Crit Care Med, Chongqing, Peoples R China; [Yang, Fuxun] Univ Elect Sci & Technol China, Sichuan Prov Peoples Hosp, Dept ICU, Chengdu, Peoples R China; [He, Dehua; Chen, Qimin] Guizhou Med Univ, Affiliated Hosp, Dept Crit Care Med, Guiyang, Guizhou, Peoples R China; [Wei, Bilin] Sun Yat Sen Univ, Affiliated Hosp 1, Dept Crit Care Med, Guangzhou, Peoples R China; [Chen, Baixu] Sichuan Univ, West China Hosp, Dept Crit Care Med, Chengdu, Sichuan, Peoples R China; [Li, Liucun] Cent South Univ, Xiangya Hosp 2, Dept Resp & Crit Care Med, Changsha, Hunan, Peoples R China; [Tang, Manyun] Chest Hosp Xian, Dept Tradit Med & Rehabil, Xian, Peoples R China; [Yuan, Guodan] Chonqing Publ Hlth Med Ctr, Dept Crit Care Med, Chongqing, Peoples R China; [Ding, Fei] Chongqing Med Univ, Bishan Hosp, Dept Resp & Crit Care Med, Chongqing, Peoples R China; [Huang, Tao] Chongqing Med Univ, Affiliated Hosp 1, Dept Crit Care Med, Chongqing, Peoples R China; [Zhang, Zhongxing] Chongqing Three Gorges Med Coll, Affiliated Hosp, Dept Resp & Crit Care Med, Chongqing, Peoples R China; [Tang, ZhiJun] Peoples Hosp Nanchuan, Dept Resp & Crit Care Med, Chongqing, Peoples R China; [Mina, Bushra] Northwell Hlth, Div Pulm & Crit Care Med, Dept Med, Lenox Hill Hosp, New York, NY USA"

通信作者："Duan, J (通讯作者)，Chongqing Med Univ, Affiliated Hosp 1, Dept Resp & Crit Care Med, Youyi Rd 1, Chongqing 400016, Peoples R China."

来源：CRITICAL CARE

ESI学科分类：　

WOS号：WOS:000820257500002

JCR分区：Q1

影响因子：15.1

年份：2022

卷号：26

期号：1

开始页：　

结束页：　

文献类型：Article

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

摘要："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."

基金机构：Pei Yu Ji Jin of the First Affiliated Hospital of Chongqing Medical University [PYJJ201707]

基金资助正文：This study was supported by Pei Yu Ji Jin of the First Affiliated Hospital of Chongqing Medical University (PYJJ201707).