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

Steer J et al

These researchers analysed admission data and in-hospital deaths among 920 consecutive patients hospitalised for a COPD exacerbation to identify outcome predictors; mean FEV1 was 43.6% of predicted and 10.4% of patients died in hospital. They then combined the five strongest mortality predictors to form the ‘DECAF’ score. DECAF exhibited excellent discrimination for mortality (area under the receiver operator characteristic curve 0.86 [95% CI 0.82, 0.89]). Moreover, DECAF performed better than other clinical prediction tools; for example, it was a significantly stronger predictor of mortality than CURB-65 in 299 patients with coexistent pneumonia.
Comment

This study comes from Newcastle upon Tyne, where I completed my training in respiratory medicine. The authors reflected on the fact that the BODE index predicts mortality risk in stable COPD patients; however, no simple score estimates the mortality in patients admitted with an acute exacerbation of COPD. After recruiting 920 patients with an acute exacerbation of COPD in two hospitals over an 18-month period, they found that about 10% died during admission. Furthermore, they found that the five strongest predictors of mortality were Dyspnoea, Eosinopenia, Consolidation, Acidaemia and atrial Fibrillation (DECAF). Bottom line: this simple clinical prediction tool can accurately stratify patients who are admitted with an acute exacerbation of COPD.
Reference: Thorax 2012;67(11):970–6

http://thorax.bmj.com/content/67/11/970