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. 2022 Nov;17(8):2367-2377.
doi: 10.1007/s11739-022-03058-x. Epub 2022 Aug 2.

Role of prognostic scores in predicting in-hospital mortality and failure of non-invasive ventilation in adults with COVID-19

Francesca Innocenti  1 , Cristian Lazzari  2 , Elisa Paolucci  2 , Anna De Paris  2 , Alessia Lagomarsini  2 , Federica Guerra  2 , Patrizia Alleonato  2 , Lisa Casalini  2 , Michele Buggea  2 , Francesca Caldi  2 , Maurizio Zanobetti  2 , Filippo Pieralli  3 , Giulia Guazzini  3 , Lisa Lastraioli  3 , Fabio Luise  3 , Alessandro Milia  3 , Lucia Sammicheli  3 , Lucia Maddaluni  2 , Federico Lavorini  4 , Riccardo Pini  2   4
Affiliations

Role of prognostic scores in predicting in-hospital mortality and failure of non-invasive ventilation in adults with COVID-19

Francesca Innocenti et al. Intern Emerg Med. 2022 Nov.

Abstract

We tested the prognostic performance of different scores for the identification of subjects with acute respiratory failure by COVID-19, at risk of in-hospital mortality and NIV failure. We conducted a retrospective study, in the Medical High-Dependency Unit of the University-Hospital Careggi. We included all subjects with COVID-19 and ARF requiring non-invasive ventilation (NIV) between March 2020 and January 2021. Clinical parameters, the HACOR score (Heart rate, Acidosis, Consciousness, Oxygenation, Respiratory Rate) and ROX index ((SpO2/FiO2)/respiratory rate) were collected 3 (-3) and 1 day (-1) before the NIV initiation, the first day of treatment (Day0) and after 1 (+1), 2 (+2), 5 (+5), 8 (+8) and 11 (+11) of treatment. The primary outcomes were in-hospital mortality and NIV failure. We included 135 subjects, mean age 69±13 years, 69% male. Patients, who needed mechanical ventilation, showed a higher HACOR score (Day0: 6 [5-7] vs 6 [6-7], p=.057; Day+2: 6 [6-6] vs 6 [4-6], p=.013) and a lower ROX index (Day0: 4.2±2.3 vs 5.1±2.3, p=.055; Day+2: 4.4±1.2.vs 5.5±1.3, p=.001) than those with successful NIV. An HACOR score >5 was more frequent among nonsurvivors (Day0: 82% vs 58%; Day2: 82% vs 48%, all p<0.01) and it was associated with in-hospital mortality (Day0: RR 5.88, 95%CI 2.01-17.22; Day2: RR 4.33, 95%CI 1.64-11.41) independent to age and Charlson index. In conclusion, in subjects treated with NIV for ARF caused by COVID19, respiratory parameters collected after the beginning of NIV allowed to identify those at risk of an adverse outcome. An HACOR score >5 was independently associated with increased mortality rate.

Keywords: COVID-19; Non-invasive ventilation; Prognosis; Respiratory failure.

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Conflict of interest statement

No conflict of interest to declare.

Figures

Fig. 1
Fig. 1
Values of P/F ratio, alveolar-arterial gradient, ROX index and HACOR score at all the evaluations in survivors and non-survivors (on the left) in subjects with successful and failed NIV (on the right). The values of the HACOR score are reported as median and interquartile range, while all the other parameters are reported as mean ± standard deviation
Fig. 2
Fig. 2
Proportion of survivors and non-survivors (A, B) and subjects with successful and failed NIV (C, D) with HACOR score > 5 and ROX index < 4.88
Fig. 3
Fig. 3
Probability of NIV failure in subjects with good and adverse prognosis
See this image and copyright information in PMC

Comment in

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