The DECAF Score: predicting hospital mortality in exacerbations of chronic obstructive pulmonary disease

Abstract

Background Despite exacerbations of chronic obstructive pulmonary disease (COPD) being both common and often fatal, accurate prognostication of patients hospitalised with an exacerbation is difficult. For exacerbations complicated by pneumonia, the CURB-65 prognostic tool is frequently used but its use in this population is suboptimal. Methods Consecutive patients hospitalised with an exacerbation of COPD were recruited. Admission clinical data and inhospital death rates were recorded. Independent predictors of outcome were identified by logistic regression analysis and incorporated into a clinical prediction tool. Results 920 patients were recruited: mean (SD) age was 73.1 (10.0) years; 53.9% were female subjects; mean (SD) forced expiratory volume in one second was 43.6 (17.2) % predicted; and 96 patients (10.4%) died in hospital. The five strongest predictors of mortality (extended MRC Dyspnoea Score, eosinopenia, consolidation, acidaemia, and atrial fibrillation) were combined to form the Dyspnoea, Eosinopenia, Consolidation, Acidaemia and atrial Fibrillation (DECAF) Score. The Score, which underwent internal bootstrap validation, showed excellent discrimination for mortality (area under the receiver operator characteristic curve ¼0.86, 95% CI 0.82 to 0.89) and performed more strongly than other clinical prediction tools. In the subgroup of patients with coexistent pneumonia (n¼299), DECAF was a significantly stronger predictor of mortality than CURB-65. Conclusions The DECAF Score is a simple yet effective predictor of mortality in patients hospitalised with an exacerbation of COPD and has the potential to help clinicians more accurately predict prognosis, and triage place and level of care to improve outcome in this common condition.

Effects of Pulmonary Rehabilitation on Exacerbation Number and Severity in People With COPD

“…4 Patients experience on average 1-3 treated exacerbations per year 5 with up to 10% of patients dying during a hospital admission for AECOPD 6 and up to 25% within a year of admission for AECOPD. 7 Pulmonary rehabilitation is a key component of the multi-disciplinary management of COPD 8 and can improve exercise capacity, dyspnoea, activities of daily living, muscle strength, self-efficacy, and quality of life.…”

Clinical Factors Associated with an Increased Risk of Death at and During Hospitalization for an Acute Exacerbation of COPD (AECOPD) and for a Short Period after Discharge

“…Finally, in order to define a specific score evaluating the prognosis of hospitalized AECOPD, an English prospective study [24] involving more than 900 patients has found the five strongest independent predictors of death during hospitalization (extended MRC Dyspnoea Score, eosinopenia, consolidation, acidaemia, and atrial fibrillation), then combined into a clinical prediction score (DECAF, Dyspnoea, Eosinopenia, Consolidation, Acidaemia and atrial Fibrillation). Supported by an internal bootstrap validation, the DECAF score [24] demonstrates excellent ability in the discrimination of patient deaths during hospitalization (area under the receiver operator characteristic curve-AUC = 0.86, 95% CI 0.82 to 0.89).…”

The DECAF Score is a Superior Predictor of In-hospital Death than the BAP-65 Score

“…However, DECAF showed consistent and excellent discrimination in the derivation and validation studies (area under the receiver operator characteristic (AUROC) curve 0.86 and 0.83 respectively) [3,4] and outperformed BAP-65, which performed inconsistently (AUROC 0.65 and 0.77 respectively). One potential weakness of BAP-65 is that the assessment of mental status may vary, despite their claim that the BAP-65 indices are objective.…”

“…Furthermore, the provision of salbutamol nebulisers by paramedics prior to admission can elevate pulse rate, and reduce its prognostic power. In the DECAF derivation study [3], pulse rate was not associated with in-hospital mortality.…”