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

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          Abstract

          Introduction

          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.

          Methods

          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 PaO 2/FiO 2 < 300 and PaCO 2 < 45 mmHg, who received CPAP. One hour after starting CPAP, HACOR was calculated.

          Results

          We enrolled 128 patients, mean age 61,7 years. Mean HACOR at 1 h after starting CPAP was 3,27 ± 3,84 and mean PaO 2/FiO 2 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 PaO 2/FiO2 accuracy was 81,25 %.

          Conclusion

          Although HACOR score had a good diagnostic performance in predicting CPAP failure in COVID-19-related ARF, PaO 2/FiO 2 has also shown to be a good predictor of failure.

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          Most cited references18

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          Clinical course and outcomes of critically ill patients with SARS-CoV-2 pneumonia in Wuhan, China: a single-centered, retrospective, observational study

          Xiaobo Yang, Yuan Yu, Jiqian Xu … (2020)
          Summary Background An ongoing outbreak of pneumonia associated with the severe acute respiratory coronavirus 2 (SARS-CoV-2) started in December, 2019, in Wuhan, China. Information about critically ill patients with SARS-CoV-2 infection is scarce. We aimed to describe the clinical course and outcomes of critically ill patients with SARS-CoV-2 pneumonia. Methods In this single-centered, retrospective, observational study, we enrolled 52 critically ill adult patients with SARS-CoV-2 pneumonia who were admitted to the intensive care unit (ICU) of Wuhan Jin Yin-tan hospital (Wuhan, China) between late December, 2019, and Jan 26, 2020. Demographic data, symptoms, laboratory values, comorbidities, treatments, and clinical outcomes were all collected. Data were compared between survivors and non-survivors. The primary outcome was 28-day mortality, as of Feb 9, 2020. Secondary outcomes included incidence of SARS-CoV-2-related acute respiratory distress syndrome (ARDS) and the proportion of patients requiring mechanical ventilation. Findings Of 710 patients with SARS-CoV-2 pneumonia, 52 critically ill adult patients were included. The mean age of the 52 patients was 59·7 (SD 13·3) years, 35 (67%) were men, 21 (40%) had chronic illness, 51 (98%) had fever. 32 (61·5%) patients had died at 28 days, and the median duration from admission to the intensive care unit (ICU) to death was 7 (IQR 3–11) days for non-survivors. Compared with survivors, non-survivors were older (64·6 years [11·2] vs 51·9 years [12·9]), more likely to develop ARDS (26 [81%] patients vs 9 [45%] patients), and more likely to receive mechanical ventilation (30 [94%] patients vs 7 [35%] patients), either invasively or non-invasively. Most patients had organ function damage, including 35 (67%) with ARDS, 15 (29%) with acute kidney injury, 12 (23%) with cardiac injury, 15 (29%) with liver dysfunction, and one (2%) with pneumothorax. 37 (71%) patients required mechanical ventilation. Hospital-acquired infection occurred in seven (13·5%) patients. Interpretation The mortality of critically ill patients with SARS-CoV-2 pneumonia is considerable. The survival time of the non-survivors is likely to be within 1–2 weeks after ICU admission. Older patients (>65 years) with comorbidities and ARDS are at increased risk of death. The severity of SARS-CoV-2 pneumonia poses great strain on critical care resources in hospitals, especially if they are not adequately staffed or resourced. Funding None.
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            Baseline Characteristics and Outcomes of 1591 Patients Infected With SARS-CoV-2 Admitted to ICUs of the Lombardy Region, Italy

            Giacomo Grasselli, Alberto Zangrillo, Alberto Zanella … (2020)
            In December 2019, a novel coronavirus (severe acute respiratory syndrome coronavirus 2 [SARS-CoV-2]) emerged in China and has spread globally, creating a pandemic. Information about the clinical characteristics of infected patients who require intensive care is limited.
            Article 0 comments Cited 2761 times – based on 0 reviews     Review now
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              The pathogenesis and treatment of the `Cytokine Storm' in COVID-19

              Qing Ye, Bili Wang, Jianhua Mao (2020)
              Summary Cytokine storm is an excessive immune response to external stimuli. The pathogenesis of the cytokine storm is complex. The disease progresses rapidly, and the mortality is high. Certain evidence shows that, during the coronavirus disease 2019 (COVID-19) epidemic, the severe deterioration of some patients has been closely related to the cytokine storm in their bodies. This article reviews the occurrence mechanism and treatment strategies of the COVID-19 virus-induced inflammatory storm in attempt to provide valuable medication guidance for clinical treatment.
              Article 0 comments Cited 1432 times – based on 0 reviews     Review now
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                Author and article information

                Journal
                Journal ID (nlm-ta): Respir Med
                Journal ID (iso-abbrev): Respir Med
                Title: Respiratory Medicine
                Publisher: Elsevier Ltd.
                ISSN (Print): 0954-6111
                ISSN (Electronic): 1532-3064
                Publication date PMC-release: 27 July 2021
                Publication date (Print): October 2021
                Publication date (Electronic): 27 July 2021
                Volume: 187
                Page: 106550
                Affiliations
                [a ]Pulmonology Department, Hospital Prof. Doutor Fernando Fonseca; IC19, 2720-276 Amadora, Portugal
                [b ]Pulmonology Department, Monaldi Hospital, Via Leonardo Bianchi, 80131 Naples, Italy
                [c ]Pulmonary Critical Care Division, Lung Center, Northwell/Lenox Hill Hospital, 100 E 77th St., New York, USA
                [d ]Intensive Care Unit, Morales Meseguer Hospital; Av Marqués de Los Vélez, S/n, 30008 Murcia, Spain
                [e ]Pulmonology Department and Respiratory Intensive Care Unit, San Donato Hospital; Via Pietro Nenni, 20/22, 52100 Arezzo, Italy
                Author notes
                [∗ ]Corresponding author. Martins de Matos Navarro Guia, Hospital Prof. Doutor Fernando Fonseca; IC19, 2720-276 Amadora, Portugal.
                Article
                Publisher Item ID: S0954-6111(21)00256-0 Publisher ID: 106550
                DOI: 10.1016/j.rmed.2021.106550
                PMC ID: 8313899
                PubMed ID: 34333389
                SO-VID: 26620f9b-3468-4bd3-b9b7-859477b68b46
                Copyright © © 2021 Elsevier Ltd. All rights reserved.
                License:

                Since January 2020 Elsevier has created a COVID-19 resource centre with free information in English and Mandarin on the novel coronavirus COVID-19. The COVID-19 resource centre is hosted on Elsevier Connect, the company's public news and information website. Elsevier hereby grants permission to make all its COVID-19-related research that is available on the COVID-19 resource centre - including this research content - immediately available in PubMed Central and other publicly funded repositories, such as the WHO COVID database with rights for unrestricted research re-use and analyses in any form or by any means with acknowledgement of the original source. These permissions are granted for free by Elsevier for as long as the COVID-19 resource centre remains active.

                History
                Date received : 3 March 2021
                Date revision received : 13 July 2021
                Date accepted : 23 July 2021
                Categories
                Subject: Article

                Keywords: covid-19,hypoxemic acute respiratory failure,cpap,hacor score
                Data availability:
                Keywords: covid-19, hypoxemic acute respiratory failure, cpap, hacor score

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