Hacor Score In Predicting Non-Invasive Ventilation Failure In Acute Hypoxemic Respiratory Failure

Abstract

Background: Non-invasive ventilation (NIV) is a frontline strategy for managing acute hypoxemic respiratory failure (AHRF), but its success varies. Delayed recognition of NIV failure can increase mortality. The HACOR score, incorporating heart rate, acidosis, consciousness, oxygenation, and respiratory rate, has emerged as a potential tool for early prediction of NIV outcomes.

Methods: A prospective observational study was conducted on 75 patients with AHRF receiving NIV at a tertiary care hospital. HACOR scores were calculated at initiation, and at 1, 12, and 24 hours. A score >5 was used as the threshold for predicting NIV failure. Outcomes were categorized as NIV success (weaning) or failure (need for intubation).

Results: Patients who failed NIV had consistently higher HACOR scores at all time points. A score >5 showed high sensitivity (82% at 1 hour) and specificity (88%), with strong positive predictive value (>90%). NIV failure was more common in patients with ARDS and malignancy, while pneumonia patients responded better. Early intubation in high HACOR scorers was associated with reduced hospital mortality compared to delayed intubation.

Conclusion: The HACOR score is a reliable, simple bedside tool for predicting NIV failure in AHRF. A score >5, particularly within the first hour of NIV, warrants closer monitoring and may prompt timely intubation to improve outcomes.