open access

Vol 89, No 1 (2021)
Research paper
Published online: 2021-02-28
Submitted: 2020-09-07
Accepted: 2020-10-21
Get Citation

The utility of HACOR score in predicting failure of high-flow nasal oxygen in acute hypoxemic respiratory failure

Doaa M Magdy, Ahmed Metwally
DOI: 10.5603/ARM.a2021.0031
·
Pubmed: 33660245
·
Adv Respir Med 2021;89(1):23-29.

open access

Vol 89, No 1 (2021)
ORIGINAL PAPERS
Published online: 2021-02-28
Submitted: 2020-09-07
Accepted: 2020-10-21

Abstract

Objectives: To assess the diagnostic performance of HACOR scoring system using bedside variables and to predict failure of HFNO in patients with acute hypoxemic respiratory failure (AHRF).
Material and methods: 150 patients with AHRF who were receiving HFNO were enrolled in this study; to predict HFNO treatment failure. A scoring scale (HACOR score) consisted of Heart rate (beats/minute), acidosis (assessed by pH), consciousness (assessed by Glasgow coma score), oxygenation, and respiratory rate. Failure was defined as the need for intubation or death.
Results: Patients were analyzed according to the success or failure of HFNO. Total 150 patients, of which 100 (66.7%) had a successful treatment while 50 (33.3%) failed with such intervention. There was an improvement in HR and RR, and PaO2/FiO2 within the first hour (T1) in the success group and these parameters continued to improve even after 24 hours (T2) of HFNO treatment. Patients with HFNO failure had a higher HACOR score at initiation and after 1, 12, 24 and 48 hours. Before intubation, the highest value of the HACOR score was reached in the failure group. At 1 h of HFNO assessment, the area under the receiver operating characteristic curve was 0.86, showing good predictive power for failure. We found that HACOR score at a cutoff point > 6 had 81.2% sensitivity and 91% specificity, 92.5% positive predictive value, and 71.4% negative predictive value with a diagnostic accuracy was 85%. Furthermore, the overall diagnostic accuracy exceeded 87% when the HACOR score was assessed at 1, 12, 24 or 48 h of HFNO.
Conclusions: The HACOR scale is a clinically useful bedside tool for the prediction of HFNO failure in hypoxemic patients. A HACOR score < 6 after 1 hour of HFNO highlights patients with < 85% risk of failure.

Abstract

Objectives: To assess the diagnostic performance of HACOR scoring system using bedside variables and to predict failure of HFNO in patients with acute hypoxemic respiratory failure (AHRF).
Material and methods: 150 patients with AHRF who were receiving HFNO were enrolled in this study; to predict HFNO treatment failure. A scoring scale (HACOR score) consisted of Heart rate (beats/minute), acidosis (assessed by pH), consciousness (assessed by Glasgow coma score), oxygenation, and respiratory rate. Failure was defined as the need for intubation or death.
Results: Patients were analyzed according to the success or failure of HFNO. Total 150 patients, of which 100 (66.7%) had a successful treatment while 50 (33.3%) failed with such intervention. There was an improvement in HR and RR, and PaO2/FiO2 within the first hour (T1) in the success group and these parameters continued to improve even after 24 hours (T2) of HFNO treatment. Patients with HFNO failure had a higher HACOR score at initiation and after 1, 12, 24 and 48 hours. Before intubation, the highest value of the HACOR score was reached in the failure group. At 1 h of HFNO assessment, the area under the receiver operating characteristic curve was 0.86, showing good predictive power for failure. We found that HACOR score at a cutoff point > 6 had 81.2% sensitivity and 91% specificity, 92.5% positive predictive value, and 71.4% negative predictive value with a diagnostic accuracy was 85%. Furthermore, the overall diagnostic accuracy exceeded 87% when the HACOR score was assessed at 1, 12, 24 or 48 h of HFNO.
Conclusions: The HACOR scale is a clinically useful bedside tool for the prediction of HFNO failure in hypoxemic patients. A HACOR score < 6 after 1 hour of HFNO highlights patients with < 85% risk of failure.

Get Citation

Keywords

hypoxemic respiratory failure; critical care

About this article
Title

The utility of HACOR score in predicting failure of high-flow nasal oxygen in acute hypoxemic respiratory failure

Journal

Advances in Respiratory Medicine

Issue

Vol 89, No 1 (2021)

Article type

Research paper

Pages

23-29

Published online

2021-02-28

DOI

10.5603/ARM.a2021.0031

Pubmed

33660245

Bibliographic record

Adv Respir Med 2021;89(1):23-29.

Keywords

hypoxemic respiratory failure
critical care

Authors

Doaa M Magdy
Ahmed Metwally

References (11)
  1. Roca O, Riera J, Torres F, et al. High-flow oxygen therapy in acute respiratory failure. Respir Care. 2010; 55(4): 408–413.
  2. Sztrymf B, Messika J, Mayot T, et al. Impact of high-flow nasal cannula oxygen therapy on intensive care unit patients with acute respiratory failure: a prospective observational study. J Crit Care. 2012; 27(3): 324.e9–324.13.
  3. Peters SG, Holets SR, Gay PC. High-flow nasal cannula therapy in do-not-intubate patients with hypoxemic respiratory distress. Respir Care. 2013; 58(4): 597–600.
  4. Duan J, Han X, Bai L, et al. Assessment of heart rate, acidosis, consciousness, oxygenation, and respiratory rate to predict noninvasive ventilation failure in hypoxemic patients. Intensive Care Med. 2017; 43(2): 192–199.
  5. Agarwal R, Handa A, Aggarwal AN, et al. Outcomes of noninvasive ventilation in acute hypoxemic respiratory failure in a respiratory intensive care unit in North India. Respir Care. 2009; 54: 1679–87.
  6. Brochard L, Mancebo J, Wysocki M, et al. Noninvasive ventilation for acute exacerbations of chronic obstructive pulmonary disease. N Engl J Med. 1995; 333(13): 817–822.
  7. Knaus WA, Draper EA, Wagner DP, et al. APACHE II: a severity of disease classification system. Crit Care Med. 1985; 13(10): 818–829.
  8. Spoletini G, Alotaibi M, Blasi F, et al. Heated humidified high-flow nasal oxygen in adults: mechanisms of action and clinical implications. Chest. 2015; 148(1): 253–261.
  9. Kang BJu, Koh Y, Lim CM, et al. Failure of high-flow nasal cannula therapy may delay intubation and increase mortality. Intensive Care Med. 2015; 41(4): 623–632.
  10. Duan J, Bai L, Duan J, et al. Early prediction of noninvasive ventilation failure in COPD patients: derivation, internal validation, and external validation of a simple risk score. Ann Intensive Care. 2019; 9(1): 108.
  11. Frat JP, Thille A, Mercat A, et al. High-Flow oxygen through nasal cannula in acute hypoxemic respiratory failure. New England Journal of Medicine. 2015; 372(23): 2185–2196.

Important: This website uses cookies. More >>

The cookies allow us to identify your computer and find out details about your last visit. They remembering whether you've visited the site before, so that you remain logged in - or to help us work out how many new website visitors we get each month. Most internet browsers accept cookies automatically, but you can change the settings of your browser to erase cookies or prevent automatic acceptance if you prefer.

Czasopismo Pneumonologia i Alergologia Polska dostęne jest również w Ikamed - księgarnia medyczna

Wydawcą serwisu jest "Via Medica sp. z o.o." sp.k., ul. Świętokrzyska 73, 80–180 Gdańsk

tel.:+48 58 320 94 94, faks:+48 58 320 94 60, e-mail: viamedica@viamedica.pl