HACOR SCORE

HACOR SCORE

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HACOR AND noninvasive ventilation

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HACOR score components points NIV failure official study

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HACOR score noninvasive ventilation failure

HACOR predicts risk of noninvasive ventilation (NIV) failure in acute respiratory failure. Calculate it at baseline and particularly after 1 hour of NIV.

Component	Category	Points
Heart rate, beats/min	≤120	0
	≥121	1
Acidosis, arterial pH	≥7.35	0
	7.30-7.34	2
	7.25-7.29	3
	<7.25	4
Consciousness, GCS	15	0
	13-14	2
	11-12	5
	≤10	10
Oxygenation, PaO₂/FiO₂	≥201	0
	176-200	2
	151-175	3
	126-150	4
	≤100	6
Respiratory rate, breaths/min	≤30	0
	31-35	1
	36-40	2
	41-45	3
	≥46	4

Total: 0-25 points.

Interpretation

HACOR >5 after 1 hour of NIV suggests a high risk of NIV failure and should prompt urgent reassessment, close monitoring, and consideration of timely intubation where clinically appropriate.
It is a risk-stratification aid, not a substitute for clinical judgment. Immediate intubation may be required regardless of score for inability to protect the airway, severe shock, worsening consciousness, refractory hypoxemia, or respiratory arrest.

Example

HR 130 = 1; pH 7.28 = 3; GCS 15 = 0; PaO₂/FiO₂ 140 = 4; RR 38 = 2.
HACOR = 10, indicating high risk of NIV failure.

The original score was developed primarily for hypoxemic respiratory failure. An updated HACOR version also incorporates baseline risk factors such as pneumonia, cardiogenic pulmonary edema, pulmonary ARDS, immunosuppression, septic shock, and SOFA score. The original threshold above is from Murray & Nadel's Textbook of Respiratory Medicine, Table 136.3; the updated score was assessed in a multicenter prospective study.

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