HACOR Score may predict NIV Failure among Post-TB Obstructive Airway Disease Patients: Study

INDIA: A recent study published in the Journal of the Association of Physicians of India concluded that The HACOR score is useful for predicting the likelihood of non-invasive ventilation (NIV) failure in patients experiencing an acute exacerbation of post-tuberculosis obstructive airway disease (TB-OAD).

Post- Post-Tuberculosis obstructive airway disease is associated with pulmonary TB. In India, smoking is a common cause of chronic AOD. Cough, breathlessness, obstructive abnormality, and spirometry are the symptoms which are associated with it. Inhaled steroids and inhaled bronchodilators are the mainstay treatment of post-TB-OAD. Hypoxia and respiratory fatigue are the indicators for hospitalization. Considering this, Siddharth R Waghmare, from the Department of Respiratory Medicine, Lokmanya Tilak Municipal Medical College and General Hospital (LTMGH), Mumbai, Maharashtra, India, et.al conducted a study to assess the utility of HACOR score in acute exacerbation of post- tuberculosis obstructive airway disease ( post – TB-OAD).

For this purpose, the research team conducted an observational study with 100 patients with acute exacerbation of post-TB-OAD. HACOR score was calculated for patients in acute exacerbation of post-TB-OAD who needed non-invasive ventilation (NIV) support in 1,12,24,48 hours. A cutoff score of >5 was used, and the specificity, sensitivity, positive predictive value, and negative predicted value were calculated.

After 1 hour of the NIV trial, the receiver operating characteristic (ROC) curve was plotted based on the HACOR score. Paired t-test was used to analyze the trend in HACOR scores in subjects requiring NIV for up to 2 days. To calculate sensitivity and specificity truth table was used for evaluation.

They found the following results: -

• Out of 100 patients, 38 were classified in the NIV failure group. The average HACOR score at 1 hour for this group was 9.47.
• For a score greater than 5, the sensitivity was 89.47% and the specificity was 87.09%. The positive predictive value was 80.95%, while the negative predictive value was 93.10%.
• The area under the ROC curve (AUC) was 0.853. In the NIV failure group, the mean score increased over time, whereas in the NIV success group, it decreased.
• The change in the score in the NIV success group was statistically significant
• In the NIV failure group, 34 patients had HACOR scores above 5, whereas only 8 patients in the NIV success group had scores above this threshold. The sensitivity of the score was 89.47%, and the specificity was 87.09%.
• The positive predictive value of the score was 80.95%, and the negative predictive value was 93.10%. ROC analysis of the HACOR score at 1 hour revealed an area under the curve of 0.853.

“HACOR score can be used to predict failure in post-TB-OAD patients. HACOR score demonstrates higher specificity and negative predictive value in predicting NIV failure. Patients whose scores >5 require more frequent monitoring whereas an increasing score is considered as a harbinger of impending NIV failure.”, the researchers concluded.

Reference:

Waghmare, S. R. (2024, August 1). Utility of the HACOR score in patients with acute exacerbation of post-tuberculosis obstructive airway disease: A retrospective observational study. The Journal of the Association of Physicians of India, Volume 72, Issue 8, P26-29, August 2024. https://www.japi.org/article/japi-72-8-26