Mannarino Massimo Raffaele, Bianconi Vanessa, Cosentini Elena, Figorilli Filippo, Natali Costanza, Cellini Giulia, Colangelo Cecilia, Giglioni Francesco, Braca Marco, Pirro Matteo
Unit of Internal Medicine, Department of Medicine and Surgery, University of Perugia, 06129 Perugia, Italy.
J Clin Med. 2022 Jun 18;11(12):3509. doi: 10.3390/jcm11123509.
Non-invasive respiratory support (NIRS) is widely used in COVID-19 patients, although high rates of NIRS failure are reported. Early detection of NIRS failure and promptly defining the need for intubation are crucial for the management of patients with acute respiratory failure (ARF). We tested the ability of the HACOR score¸ a scale based on clinical and laboratory parameters, to predict adverse outcomes in hospitalized COVID-19 patients with ARF. Four hundred patients were categorized according to high (>5) or low (≤5) HACOR scores measured at baseline and 1 h after the start of NIRS treatment. The association between a high HACOR score and either in-hospital death or the need for intubation was evaluated. NIRS was employed in 161 patients. Forty patients (10%) underwent intubation and 98 (25%) patients died. A baseline HACOR score > 5 was associated with the need for intubation or in-hospital death in the whole population (HR 4.3; p < 0.001), in the subgroup of patients who underwent NIRS (HR 5.2; p < 0.001) and in no-NIRS subgroup (HR 7.9; p < 0.001). In the NIRS subgroup, along with the baseline HACOR score, also 1-h HACOR score predicted NIRS failure (HR 2.6; p = 0.039). In conclusion, the HACOR score is a significant predictor of adverse clinical outcomes in patients with COVID-19-related ARF.
无创呼吸支持（NIRS）在新冠病毒病（COVID-19）患者中广泛应用，尽管报告显示NIRS失败率较高。早期发现NIRS失败并及时确定插管需求对于急性呼吸衰竭（ARF）患者的管理至关重要。我们测试了基于临床和实验室参数的HACOR评分量表预测住院COVID-19合并ARF患者不良结局的能力。400例患者根据基线时及NIRS治疗开始后1小时测得的HACOR评分高（>5）或低（≤5）进行分类。评估了高HACOR评分与院内死亡或插管需求之间的关联。161例患者采用了NIRS。40例（10%）患者接受了插管，98例（25%）患者死亡。基线HACOR评分>5与整个人群（风险比4.3；p<0.001）、接受NIRS的患者亚组（风险比5.2；p<0.001）和未接受NIRS的亚组（风险比7.9；p<0.001）的插管需求或院内死亡相关。在接受NIRS的亚组中，除了基线HACOR评分外，1小时HACOR评分也可预测NIRS失败（风险比2.6；p=0.039）。总之，HACOR评分是COVID-19相关ARF患者不良临床结局的重要预测指标。
