A Prospective Observational Study to Evaluate the Efficacy of Hacor Score In Predicting NIV Failure In ICU Setting of A Tertiary Care Centre
Year: 2025
Type: article
Study design: Observational Study
Abstract: INTRODUCTION: The use of noninvasive ventilation (NIV) in critically ill patients has dramatically increased(1) as it significantly reduces the work of breathing in patients with acute respiratory failure, thereby reducing the need for intubation(2,3). NIV, reduces respiratory rate, decreases PaCO2 and improves the level of consciousness. NIV offers a range of advantages like minimizing the risk of ventilator-associated pneumonia and the need for sedation. It also preserves airway clearance and swallowing, allows oral patency and intermittent ventilation so that normal eating, drinking and communication are permitted(4,5,6). Although NIV is frequently used in patients with respiratory failure, its failure rate remains high (25–59%)(7–12) indicating that not all patients benefit from this treatment. And delayed intubation is associated with increased hospital mortality(13,14,15). Thus, the early identification of patients who cannot benefit from NIV is important. Assessment of the patients who respond well to NIV can reduce unnecessary intubation and ventilator-associated complications. Previous studies have reported that patients who experience NIV failure have a higher heart rate, lower pH, Lower Glasgow Coma Scale (GCS) score, lower oxygenation, and higher respiratory rate than those who experience successful NIV. These variables can be used to predict NIV failure. However, the predictive Power of NIV failure is low when based only on a single Variable. Hypothesizing that a combination of these variables has to potential to increase the predictive HACOR score combined several variables that Were easily obtained By simple bedside measurements in patients with acute respiratory failure to develop a scale for the prediction of NIV failure. STUDY OBJECTIVES: PRIMARY OBJECTIVE: The objective of the study is To determine whether HACOR Score can help identify patients at risk of NIV failure and To compare effectiveness of HACOR score at 1 hour and 6 hours in predicting NIV failure. SECONDARY OBJECTIVE: The objective of the study is also to determine the Association of a higher HACOR Score and length of Hospital stay. MATERIALS AND METHODOLOGY: This prospective observational study which was conducted in the MDICU of PRS Hospital for a period of one year from April1, 2023 to Mar 31, 2024. SAMPLE SIZE OF 130 PATIENTS HAS BEEN CALCULATED BASED ON AN EARLIER STUDY. INCLUSION CRITERIA: Patients age> 18yrs requiring NIV Patients initiated on NIV in our Hospital. EXCLUSION CRITERIA: Patients on home CPAP/NIV. Patients in DNR/DNI status. Informed consent were obtained from patients or their relatives if they meet the inclusion Criteria. Data will be collected. Appropriate NIV settings for the patient were initiated based on patient characteristics and the etiology of acute respiratory failure. Patient were reevaluted after 1st hour of keeping NIV and after 6hrs of initiating NIV and by recording the variables like Heart Rate, pH, GCS, PaO2/FiO2 and respiratory. HACOR Score was calculated at these hours. These patients were then be followed up till discharge and out comes were recorded. Outcome of NIV failure was defined as need for intubation and mechanical ventilation and NIV success when patient improved with NIV and was discharged. The HACOR Score and NIV success or failure was then correlated by statistical analysis. For continuous variables, we shall report median value with interquartile range (IQR) or mean value and standard deviation (SD) when appropriate. For categorical variables, we shall report numbers and percentage. Unpaired Student's t test was used to analyze the normally distributed continuous variables and Mann–Whitney U test was used to analyze the non-normally distributed continuous variables. Chi-square test or Fisher's exact test will be used to analyze the categorical variables when appropriate. Statistical Analysis Data were collected manually with a data collection sheet. All statistical analysis for the study was performed using statistical software Statistical Package for the Social Sciences (SPSS) version 24.0 (IBM SPSS Statistics 2017). RESULTS: At 1 hour, HACOR score had a good predictive accuracy with The cutoff value of >5 having a sensitivity of 72.88% and specificity of 76.16%. At 6 hours, HACOR score with a cutoff of >3, showed a sensitivity of 66.67% and specificity of 88.74%. There is a strong positive correlation between the HACOR score (at both 1 and 6 hours) and the length of ICU stay (r = 0.568 at 1 hour and r = 0.641 at 6 hours, P < 0.001). This suggests that higher HACOR scores are associated with longer ICU stays. CONCLUSIONS: In conclusion, these statistical tests collectively highlight that higher HACOR score is strongly associated with NIV failure and worse ICU outcomes. The study provides robust evidence for the utility of the HACOR score in predicting incidence of NIV failure.
Authors: Naveen Jasmine, Aswathy S
Language: English
Subfield: Pulmonary and Respiratory Medicine
Field: Medicine
Domain: Health Sciences
Open Access status: diamond
OpenAlex ID: W4410920246