HACOR Score In Predicting Non-Invasive Ventilation Failure In Acute Decompensated Heart Failure And AECOAD Patients

Aim: To compare the diagnostic accuracy of HACOR score in predicting non-invasive ventilation (NIV) failure among acute exacerbation of chronic obstructive airway disease (AECOAD)and acute decompensated heart failure (ADHF)patients,and study the correlation of HACOR score with length of stay and hospital mortality rate.

Materials and Methods: A prospective observational study conducted in emergency department of Hospital Melaka.We enrolled patients who presented with acute respiratory distress started with NIV.The efficacy of the HACOR score is evaluated at several interval time points, before NIV initiation, 1 hour, 2 hours post NIV initiation.

Result: HACOR score is much lower in NIV success subgroups and 100% NIV failure rate for the HACOR score >7 at 1 hour and 2 hours of NIV.With a cut-off value of >5 at 1 hour of NIV, the diagnostic power is 86.27% with the sensitivity of 62.50% and specificity of 90.70%. Whereas at 2 hours of NIV with the HACOR score of >5,its diagnostic power is 87.50% with the sensitivity of 50% and specificity of 95%. At 0-2 hours of NIV, area under curve (AUC) for the prediction of NIV failure are 0.788, 0.868 and 0.925 respectively.

Conclusion: The HACOR has a good diagnostic accuracy when it is assess at 1–2 hours of NIV. It is convenient to use to assess the efficacy of NIV especially for heart failure patients. However, HACOR score is a weak predictor for mortality in our study. Length of hospital stay is also found to be longer for those who failed to respond to NIV in our study.