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

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/FiO < 300 and PaCO < 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/FiO 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/FiO2 accuracy was 81,25 %.

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