更新的 HACOR 评分预测无创通气失败：一项多中心前瞻性观察研究。
An updated HACOR score for predicting the failure of noninvasive ventilation: a multicenter prospective observational study.
机构信息
Department of Respiratory and Critical Care Medicine, The First Affiliated Hospital of Chongqing Medical University, Youyi Road 1, Yuzhong District, Chongqing, 400016, China.
Department of Respiratory and Critical Care Medicine, Sichuan Provincial People's Hospital, University of Electronic Science and Technology of China, Chengdu, China.
出版信息
Crit Care. 2022 Jul 3;26(1):196. doi: 10.1186/s13054-022-04060-7.
BACKGROUND
Heart rate, acidosis, consciousness, oxygenation, and respiratory rate (HACOR) have been used to predict noninvasive ventilation (NIV) failure. However, the HACOR score fails to consider baseline data. Here, we aimed to update the HACOR score to take into account baseline data and test its predictive power for NIV failure primarily after 1-2 h of NIV.
METHODS
A multicenter prospective observational study was performed in 18 hospitals in China and Turkey. Patients who received NIV because of hypoxemic respiratory failure were enrolled. In Chongqing, China, 1451 patients were enrolled in the training cohort. Outside of Chongqing, another 728 patients were enrolled in the external validation cohort.
RESULTS
Before NIV, the presence of pneumonia, cardiogenic pulmonary edema, pulmonary ARDS, immunosuppression, or septic shock and the SOFA score were strongly associated with NIV failure. These six variables as baseline data were added to the original HACOR score. The AUCs for predicting NIV failure were 0.85 (95% CI 0.84-0.87) and 0.78 (0.75-0.81) tested with the updated HACOR score assessed after 1-2 h of NIV in the training and validation cohorts, respectively. A higher AUC was observed when it was tested with the updated HACOR score compared to the original HACOR score in the training cohort (0.85 vs. 0.80, 0.86 vs. 0.81, and 0.85 vs. 0.82 after 1-2, 12, and 24 h of NIV, respectively; all p values < 0.01). Similar results were found in the validation cohort (0.78 vs. 0.71, 0.79 vs. 0.74, and 0.81 vs. 0.76, respectively; all p values < 0.01). When 7, 10.5, and 14 points of the updated HACOR score were used as cutoff values, the probability of NIV failure was 25%, 50%, and 75%, respectively. Among patients with updated HACOR scores of ≤ 7, 7.5-10.5, 11-14, and > 14 after 1-2 h of NIV, the rate of NIV failure was 12.4%, 38.2%, 67.1%, and 83.7%, respectively.
CONCLUSIONS
The updated HACOR score has high predictive power for NIV failure in patients with hypoxemic respiratory failure. It can be used to help in decision-making when NIV is used.
背景
心率、酸中毒、意识、氧合和呼吸频率（HACOR）已被用于预测无创通气（NIV）失败。然而，HACOR 评分未能考虑基线数据。在这里，我们旨在更新 HACOR 评分，以考虑基线数据，并主要在接受 NIV 治疗 1-2 小时后测试其对 NIV 失败的预测能力。
方法
在中国和土耳其的 18 家医院进行了一项多中心前瞻性观察性研究。因低氧性呼吸衰竭而接受 NIV 的患者被纳入研究。在中国重庆，1451 名患者被纳入训练队列。在重庆以外地区，另有 728 名患者被纳入外部验证队列。
结果
在接受 NIV 前，肺炎、心源性肺水肿、肺 ARDS、免疫抑制或感染性休克和 SOFA 评分与 NIV 失败强烈相关。这六个变量作为基线数据被添加到原始 HACOR 评分中。更新后的 HACOR 评分在训练和验证队列中分别在接受 1-2 小时 NIV 后评估时，预测 NIV 失败的 AUC 值分别为 0.85（95%CI 0.84-0.87）和 0.78（0.75-0.81）。与训练队列中的原始 HACOR 评分相比，使用更新后的 HACOR 评分时，AUC 更高（1-2、12 和 24 小时时的 AUC 值分别为 0.85 与 0.80、0.86 与 0.81、0.85 与 0.82；所有 p 值均<0.01）。在验证队列中也发现了类似的结果（0.78 与 0.71、0.79 与 0.74、0.81 与 0.76；所有 p 值均<0.01）。当使用更新后的 HACOR 评分的 7、10.5 和 14 点作为截断值时，NIV 失败的概率分别为 25%、50%和 75%。在更新后的 HACOR 评分≤7、7.5-10.5、11-14 和>14 的患者中，在接受 1-2 小时 NIV 治疗后，NIV 失败的发生率分别为 12.4%、38.2%、67.1%和 83.7%。
结论
更新后的 HACOR 评分对低氧性呼吸衰竭患者的 NIV 失败具有较高的预测能力。它可用于在使用 NIV 时帮助决策。
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