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Background <p>Acute hypoxemic respiratory failure (AHRF) is a common critical condition in the intensive care unit (ICU). Accurate early prediction of the risk of death is of great significance for clinical decision-making. Although HACOR score was initially used to predict the failure of non-invasive ventilation in acute hypoxemic respiratory failure (AHRF) patients, the relationship between the HACOR score and the mortality remains unclear. Therefore, a retrospective cohort study was conducted to evaluate the ability of the HACOR score to predict mortality risk in patients with AHRF.</p> Method <p>Patients diagnosed with AHRF were extracted from the MIMIC-IV database and divided into two groups (low‑risk &lt; 6 vs. high‑risk ≥ 6) based on the median HACOR score. The relationship between the HACOR score and all‑cause mortality at 28, 90, and 365 days was evaluated. To investigate the association between HACOR score and mortality in AHRF patients, restricted cubic spline (RCS) analysis and Cox proportional hazards regression were performed.</p> Result <p>This study included 2774 patients (median age 68 years, IQR 57–79; 56.1% male). The mortality rates in the high-risk group (HACOR ≥ 6) were significantly higher than those in the low-risk group (&lt; 6) at 28 days, 90 days, and 365 days (28 days: 38.3% vs. 28.2%, <i>P</i> &lt; 0.001; 90 days: 46.1% vs. 35.7%, <i>P</i> &lt; 0.001; 365 days: 52.5% vs. 44.3%, <i>P</i> &lt; 0.001). Kaplan-Meier analysis demonstrated that the survival probability of the high-risk group was lower (log-rank <i>P</i> &lt; 0.001). Cox regression analysis indicated that for every 1-point increase in the HACOR score, the risk of death significantly increased (<i>P</i> &lt; 0.001), and restricted cubic spline analysis revealed a linear association between the score and mortality, with a significant threshold effect at HACOR = 6. Subgroup analysis further showed that a HACOR score ≥ 6 was consistently associated with a 28-day mortality rate across various demographic and clinical characteristics (all <i>P</i> &lt; 0.05), reinforcing the robustness of the score.</p> Conclusion <p>This study confirmed that an increase in the HACOR score was significantly associated with an increased mortality rate at 28 days, 90 days, and 365 days in patients with AHRF. For every 1-point increase in the score, the risk of death increased, and the threshold effect was significant when HACOR = 6. These findings highlight the utility of the HACOR score for risk stratification in clinical practice.</p>

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Association between the HACOR score and mortality in patients with acute hypoxemic respiratory failure: a retrospective cohort study

  • 期刊论文

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  • 发表日期：

    2026年8月4日

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  • Ke Wang,
  • Yan Ou,
  • Lei Li

摘要

Background

Acute hypoxemic respiratory failure (AHRF) is a common critical condition in the intensive care unit (ICU). Accurate early prediction of the risk of death is of great significance for clinical decision-making. Although HACOR score was initially used to predict the failure of non-invasive ventilation in acute hypoxemic respiratory failure (AHRF) patients, the relationship between the HACOR score and the mortality remains unclear. Therefore, a retrospective cohort study was conducted to evaluate the ability of the HACOR score to predict mortality risk in patients with AHRF.

Method

Patients diagnosed with AHRF were extracted from the MIMIC-IV database and divided into two groups (low‑risk < 6 vs. high‑risk ≥ 6) based on the median HACOR score. The relationship between the HACOR score and all‑cause mortality at 28, 90, and 365 days was evaluated. To investigate the association between HACOR score and mortality in AHRF patients, restricted cubic spline (RCS) analysis and Cox proportional hazards regression were performed.

Result

This study included 2774 patients (median age 68 years, IQR 57–79; 56.1% male). The mortality rates in the high-risk group (HACOR ≥ 6) were significantly higher than those in the low-risk group (< 6) at 28 days, 90 days, and 365 days (28 days: 38.3% vs. 28.2%, P < 0.001; 90 days: 46.1% vs. 35.7%, P < 0.001; 365 days: 52.5% vs. 44.3%, P < 0.001). Kaplan-Meier analysis demonstrated that the survival probability of the high-risk group was lower (log-rank P < 0.001). Cox regression analysis indicated that for every 1-point increase in the HACOR score, the risk of death significantly increased (P < 0.001), and restricted cubic spline analysis revealed a linear association between the score and mortality, with a significant threshold effect at HACOR = 6. Subgroup analysis further showed that a HACOR score ≥ 6 was consistently associated with a 28-day mortality rate across various demographic and clinical characteristics (all P < 0.05), reinforcing the robustness of the score.

Conclusion

This study confirmed that an increase in the HACOR score was significantly associated with an increased mortality rate at 28 days, 90 days, and 365 days in patients with AHRF. For every 1-point increase in the score, the risk of death increased, and the threshold effect was significant when HACOR = 6. These findings highlight the utility of the HACOR score for risk stratification in clinical practice.