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