Usefulness of the HACOR score in predicting success of CPAP in COVID-19-related hypoxemia

Abstract

Introduction In COVID-19 associated hypoxemic acute respiratory failure (ARF) without mandatory indication for urgent endotracheal intubation, a trial of CPAP may be considered. We aimed to evaluate HACOR (heart rate, acidosis, consciousness, oxygenation, respiratory rate) score performance in these patients as predictor of CPAP failure. Methods Prospective observational multicentric study (three centers in different countries), including adult patients with SARS-CoV-2 pneumonia admitted to a respiratory intermediate care unit, presenting PaO 2 /FiO 2 < 300 and PaCO 2 < 45 mmHg, who received CPAP. One hour after starting CPAP, HACOR was calculated. Results We enrolled 128 patients, mean age 61,7 years. Mean HACOR at one hour after starting CPAP was 3,27 ± 3,84 and mean PaO 2 /FiO 2 was 203,30 ± 92,21 mmHg; 35 patients (27,3%) presented CPAP failure: 29 underwent oro-tracheal intubation and 6 died due to COVID-19 (all having a do-not-intubate order). HACOR accuracy for predicting CPAP failure was 82,03%, while PaO 2 /FiO2 accuracy was 81,25%. Conclusion Although HACOR score had a good diagnostic performance in predicting CPAP failure in COVID-19-related ARF, PaO 2 /FiO 2 has also shown to be a good predictor of failure.

Prediction of Conventional Oxygen Therapy Failure in COVID-19 Patients With Acute Respiratory Failure by Assessing Serum Lactate Concentration, PaO2/FiO2 Ratio, and Body Temperature

“…The HACOR score was not able to predict COT failure. Guia et al observed a significant correlation of HACOR scores > 5 with CPAP failure in COVID-19 patients with ARF [18]. In their study cohort, however, patients seemed to be in more severe clinical conditions, with higher RRs and significantly lower P/F ratios compared to the cohort of patients we evaluated.…”

“…The ROX (Respiratory rate -OXygenation) index, proposed by Roca et al [15] for the prediction of HFNC failure in patients with pneumonia and ARF, was shown to correlate with the need for hospital admission, mechanical ventilation, and mortality risk in COVID-19 patients [16]. The HACOR score (Heart rate, Acidosis, Consciousness level, Oxygenation and Respiratory rate), proposed by Duan et al [17] for the prediction of NIV failure in hypoxemia due to several causes, was evaluated for the prediction of CPAP failure in COVID-19 patients with ARF [18] and was found to be comparable in its predictive power to the partial arterial oxygen pressure/inspired oxygen fraction (PaO 2 /FiO 2 or P/F) ratio.…”

Predictors Of Successful Outcome Of Self-Proning And High Flow Nasal Oxygen Therapy In Patients With COVID-19 Pneumonia: A Retrospective Analysis

“…There have been several attempts to investigate predictors of failure of NIV and/or HFNO in patients with COVID-19 pneumonia such as HACOR score [14] and ROX index [15]. More recently a machine learning algorithm based on vital signs, laboratory values, and demographic data outperformed the ROX index in predicting the need for intubation in COVID-19 patients [16].…”

Non-invasive Respiratory Support in COVID-19: A Narrative Review

“…It has also been explored as a predictive score for CPAP failure in a multicenter study. Although the performance was quite good (82%), it was similar to PaO 2 /FiO 2 ratio (81.25%) ( 84 ).…”