The Positive Predictive Value of HACOR Score (Heart Rate, Acidosis, Consciousness, Oxygenation, and Respiratory Rate) in Predicting Non-Invasive Ventilation Failure in ADHF and AECOAD
DOI:
https://doi.org/10.54112/bcsrj.v6i5.2108Keywords:
Non Invasive Ventilation, Chronic Obstructive Airway Disease, Respiratory Failure, Heart failureAbstract
Noninvasive ventilation (NIV) is widely used in acute respiratory failure due to acute decompensated heart failure and acute exacerbations of chronic obstructive airway disease. Delayed recognition of NIV failure can worsen outcomes. Early risk stratification using validated bedside tools is therefore essential. Objective: Noninvasive ventilation is frequently used to treat acute respiratory failure caused by acute decompensated heart failure (ADHF) and acute exacerbations of chronic obstructive airway disease (AECOAD). To prevent intubation delays, it is essential to predict NIV failure in advance. The HACOR score is a clinical instrument for this purpose, which is based on respiratory rate, oxygenation, heart rate, acidosis, and consciousness. Methods: A descriptive study was conducted at Dr. Ziauddin Hospital, Karachi, from December 2024 to May 2025. In total, 257 individuals had acute respiratory failure on NIV. HACOR scores were obtained at baseline and 1-2 hours after the start of NIV. The requirement for endotracheal intubation within two hours of beginning NIV is the main consequence, which is known as NIV failure. Results: In this research, 54.1% of the patients were diagnosed with AECOAD, with an average age of 63.1 years (SD ±9.9). Patients with elevated HACOR scores had a significantly higher likelihood of experiencing NIV failure. The HACOR cut-off values of ≥7.5 at admission and ≥5.5 after 1–2 hours showed high predictive accuracy, with both sensitivity and specificity exceeding 96%. Among the individual factors, tachycardia, low pH, lower GCS, and impaired oxygenation were strongly associated with NIV failure (p < 0.05). Conclusion: Patients with AECOAD and ADHF can benefit from the use of the HACOR score as a bedside tool to predict NIV failure. When used promptly, it can help with early intubation decision-making, leading to better clinical outcomes.
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