The Positive the Predictive value of Heart Rate, Acidosis, Consciousness, Oxygenation and Respiratory Rate (HACOR Score) in Predicting Non-Invasive Ventilation Failure in Acute Decompensated Heart Failure and AECOAD Patients Taking NIV Failure as Gold Standard

Submission: 07 October 2025 | Acceptance: 09 November 2025 | Publication: 03 December 2025

Rawesha Hablani¹, Ashok Kumar², Ammad Hussain³, Kaneez Zehra⁴, Faria Masood⁵, Noshirwan P Gazder⁶

Ziauddin University Hospital Karachi^1,2,3,4,5,6

ABSTRACT:

OBJECTIVE

To evaluate the positive predictive value of the HACOR score for early identification of non-invasive ventilation failure in patients with acute respiratory failure secondary to AECOPD and ADHF.

METHODOLOGY

This descriptive observational study was conducted at Dr. Ziauddin Hospital, Karachi, from December 2024 to May 2025. Adults aged 18–70 years with acute respiratory failure due to AECOPD or ADHF requiring non-invasive ventilation were included. HACOR scores were recorded at baseline and 1–2 hours post-NIV initiation. NIV failure was defined as intubation within two hours. Data from 257 patients were analysed using SPSS 26, with p < 0.05 considered statistically significant.

RESULTS

Among 257 patients, 199 (77.4%) developed NIV failure. Mean HACOR scores were significantly higher in the failure group at presentation (13.22 ± 4.41 vs. 3.86 ± 1.48, p<0.001) and at 1–2 hours (12.98 ± 4.43 vs. 3.66 ± 1.39, p<0.001). HACOR showed excellent predictive accuracy, with AUCs of 100% for AECOPD and 99.9–100% for ADHF. Optimal cutoffs (≥7.5 on arrival, ≥6.5 at 1–2 hours) achieved 97–100% sensitivity and 96–100% specificity.

CONCLUSION

The HACOR score was found to be a very dependable predictor of the early NIV failure in patients with AECOPD and ADHF. Patients who needed intubation had significantly higher HACOR scores and optimal presentation and cutoffs at 1-2 hours showed close to perfect sensitivity and specificity. These results reinforce the idea that HACOR is an efficient bedside resource that can be used to identify patients who have the highest risk of NIV failure in time.

KEYWORDS

HACOR Score, Acute Exacerbation of COPD, Intubation, Non-invasive Ventilation, Respiratory Failure