Usefulness of the HACOR score in predicting success of CPAP in COVID-19-related hypoxemia

• Published in: Respiratory medicine Vol. 187; p. 106550
• Main Authors: Guia, Miguel Filipe, Boléo-Tomé, José Pedro, Imitazione, Pasquale, Polistina, Giorgio Emanuele, Alves, Carlos, Ishikawa, Oki, Ballenberger, Matthew, Mina, Bushra, Fiorentino, Giuseppe, Esquinas, Antonio, Scala, Raffaele
• Format: Journal Article
• Language: English
• Published: England Elsevier Ltd 01.10.2021
• Subjects: Acidosis; Aged; Blood Gas Analysis; Consciousness; Continuous Positive Airway Pressure; COVID-19; COVID-19 - complications; COVID-19 - physiopathology; COVID-19 - therapy; CPAP; Female; HACOR score; Heart Rate; Humans; Hypoxemic acute respiratory failure; Intubation, Intratracheal; Male; Middle Aged; Predictive Value of Tests; Prospective Studies; Respiratory Insufficiency - diagnosis; Respiratory Insufficiency - therapy; Respiratory Insufficiency - virology; Respiratory Rate; ROC Curve; Treatment Failure; COVID-19; CPAP; HACOR score; Hypoxemic acute respiratory failure
• ISSN: 0954-6111; 1532-3064; 1532-3064
• DOI: 10.1016/j.rmed.2021.106550

In COVID-19 associated hypoxemic acute respiratory failure (ARF) without mandatory indication for urgent endotracheal intubation, a trial of CPAP may be considered. We aimed to evaluate HACOR (heart rate, acidosis, consciousness, oxygenation, respiratory rate) score performance in these patients as predictor of CPAP failure. Prospective observational multicentric study (three centers in different countries), including adult patients with SARS-CoV-2 pneumonia admitted to a respiratory intermediate care unit, presenting PaO2/FiO2 < 300 and PaCO2 < 45 mmHg, who received CPAP. One hour after starting CPAP, HACOR was calculated. We enrolled 128 patients, mean age 61,7 years. Mean HACOR at 1 h after starting CPAP was 3,27 ± 3,84 and mean PaO2/FiO2 was 203,30 ± 92,21 mmHg; 35 patients (27,3 %) presented CPAP failure: 29 underwent oro-tracheal intubation and 6 died due to COVID-19 (all having a do-not-intubate order). HACOR accuracy for predicting CPAP failure was 82,03 %, while PaO2/FiO2 accuracy was 81,25 %. Although HACOR score had a good diagnostic performance in predicting CPAP failure in COVID-19-related ARF, PaO2/FiO2 has also shown to be a good predictor of failure. •There is a need for developing tools to assess early CPAP failure in COVID-19.•HACOR score has a good diagnostic performance in predicting CPAP failure in COVID-19.•PaO2/FiO2 was also shown to be a good predictor of CPAP failure in COVID-19.