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