HACOR 评分对非 COPD 合并慢性呼吸衰竭急性加重患者无创通气失败的影响。
Impact of HACOR Score on Noninvasive Ventilation Failure in Non-COPD Patients with Acute-on-Chronic Respiratory Failure.
机构信息
Department of Respiratory and Critical Care Medicine, The First Affiliated Hospital of Chongqing Medical University, Chongqing, China.
出版信息
Can Respir J. 2021 Jul 22;2021:9960667. doi: 10.1155/2021/9960667. eCollection 2021.
BACKGROUND
A rating scale that takes into account heart rate, acidosis, consciousness, oxygenation, and respiratory rate (the HACOR score) has been used to predict noninvasive ventilation (NIV) failure in patients with chronic obstructive pulmonary disease (COPD). However, the HACOR score has not been used to predict NIV failure in non-COPD patients with acute-on-chronic respiratory failure.
METHODS
This study was performed in the respiratory intensive care unit of a teaching hospital. Data had been collected prospectively between June 2011 and January 2019. We enrolled non-COPD patients who received NIV due to acute-on-chronic respiratory failure, pH < 7.35, and PaCO >45 mmHg. NIV failure was defined as requiring intubation or dying during NIV. The HACOR score was determined at initiation and after 1-2, 12, and 24 h of NIV. Scores can range from 0 to 27, with higher scores indicating a higher risk of NIV failure.
RESULTS
A total of 148 patients were enrolled in the study, 52 with sleep apnea-hypopnea syndrome, 34 with chronic thoracic sequelae, 31 with bronchiectasis, 14 with chest wall deformity, 5 with obesity-hypoventilation syndrome, and 12 with other conditions. Of the patients, 19 (13%) experienced NIV failure. From initiation to 24 h of NIV, the HACOR scores of patients who experienced NIV failure were much higher than those of patients who received successful NIV. The area under the receiver operating characteristic curve was 0.69, 0.91, 0.91, and 0.94 when the HACOR score was tested at initiation and after 1-2, 12, and 24 h of NIV, respectively. To obtain the best sensitivity and specificity, the cutoff value at initiation was 7 with a sensitivity of 68% and a specificity of 61%. After 1-2 h of NIV, it was 5 with a sensitivity of 90% and a specificity of 85%. After 12 h of NIV, it was 4 with a sensitivity of 82% and a specificity of 91%. After 24 h of NIV, it was 2 with a sensitivity of 100% and a specificity of 76%.
CONCLUSIONS
The HACOR score has high sensitivity and specificity for predicting NIV failure among non-COPD patients who receive NIV due to acute-on-chronic respiratory failure with respiratory acidosis.
背景
一种考虑心率、酸中毒、意识、氧合和呼吸频率的评分系统（HACOR 评分）已被用于预测慢性阻塞性肺疾病（COPD）患者的无创通气（NIV）失败。然而，HACOR 评分尚未用于预测伴有慢性呼吸衰竭的急性呼吸衰竭的非 COPD 患者的 NIV 失败。
方法
本研究在一家教学医院的呼吸重症监护病房进行。数据是在 2011 年 6 月至 2019 年 1 月期间前瞻性收集的。我们招募了因急性慢性呼吸衰竭、pH<7.35 和 PaCO>45mmHg 而接受 NIV 的非 COPD 患者。NIV 失败的定义为需要插管或在 NIV 期间死亡。在 NIV 开始时以及 1-2、12 和 24 小时后，确定 HACOR 评分。评分范围为 0 至 27，分数越高表示 NIV 失败的风险越高。
结果
共有 148 名患者入组，其中 52 名患有睡眠呼吸暂停低通气综合征，34 名患有慢性胸后遗症，31 名患有支气管扩张症，14 名患有胸壁畸形，5 名患有肥胖低通气综合征，12 名患有其他疾病。在这些患者中，有 19 名（13%）经历了 NIV 失败。从 NIV 开始到 24 小时，NIV 失败患者的 HACOR 评分明显高于成功接受 NIV 的患者。HACOR 评分在 NIV 开始时以及 1-2、12 和 24 小时后分别为 0.69、0.91、0.91 和 0.94 时，曲线下面积为 0.69、0.91、0.91 和 0.94。为了获得最佳的灵敏度和特异性，NIV 开始时的截断值为 7，灵敏度为 68%，特异性为 61%。在 1-2 小时后，它是 5，灵敏度为 90%，特异性为 85%。在 12 小时后，它是 4，灵敏度为 82%，特异性为 91%。在 24 小时后，它是 2，灵敏度为 100%，特异性为 76%。
结论
HACOR 评分对预测伴有呼吸性酸中毒的急性慢性呼吸衰竭接受 NIV 的非 COPD 患者的 NIV 失败具有较高的灵敏度和特异性。
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