(1484) Validation of the HACOR Score for Predicting NIV Failure in COPD Patients: A Study at NYCH+H

Introduction: Early identification of Non-Invasive Ventilation (NIV) failure is crucial for reducing mortality among COPD patients. The HACOR (Heart rate, Acidosis, Consciousness, Oxygenation, Respiratory rate) score has shown promise but needs validation across diverse populations. This study aims to validate the HACOR score in predicting NIV failure among COPD patients at NYCH+H facilities.

Methods: Data from COPD patients admitted to NYCH+H facilities between July 2022 and June 2023 were analyzed. HACOR scores, calculated 0.5-2 hours post-NIV initiation, were assessed for predictive validity regarding NIV outcomes, defined as the need for intubation or death. Baseline characteristics were summarized using mean ± SD for continuous variables and frequencies for categorical variables. Differences between NIV success and failure groups were analyzed using t-tests and chi-square tests. ROC curve analysis assessed the predictive power of the HACOR score, with the AUC quantifying its ability to distinguish between NIV success and failure. The Youden Index identified the optimal threshold for predicting NIV failure. Statistical tests were two-tailed with a significance level of p < 0.05.

Results: The mean age was 65.87 years (SD = 15.45); 53.85% were female. There were 46 patients in the NIV failure group and 136 in the NIV success group. The mortality rate in the NIV failure group was 34.78%. Overall, 25.27% experienced NIV failure. The mean HACOR score was 9.35 (SD = 5.79) in the NIV failure group and 3.28 (SD = 2.82) in the NIV success group. An independent t-test showed a statistically significant difference between the groups (t = -9.32, p = 4.12 × 10^(-17)). ROC analysis yielded an AUC of 0.80, indicating good predictive ability. The optimal HACOR score threshold was 9, with an NIV failure rate of 79.41% for scores ≥9.

Conclusions: The HACOR score shows strong predictive validity for NIV failure in COPD patients at NYCH+H facilities, with an AUC of 0.80. Patients with HACOR scores ≥9 have a higher risk of NIV failure, suggesting early intervention could improve outcomes. This study supports the HACOR score as a useful tool for clinical decision-making across diverse populations and settings.