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The DECAF Score: predicting hospital mortality in exacerbations of chronic obstructive pulmonary disease
  1. John Steer1,
  2. John Gibson2,
  3. Stephen C Bourke1,2
  1. 1Department of Respiratory Medicine, North Tyneside General Hospital, Rake Lane, North Shields, UK
  2. 2Newcastle University, Framlington Place, Newcastle-upon-Tyne, UK
  1. Correspondence to Dr John Steer, North Tyneside General Hospital, Northumbria Health NHS Foundation Trust, Rake Lane, North Shields, Tyne and Wear, NE29 8NH, UK; john_steer{at}


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 =0.86, 95% CI 0.82 to 0.89) and performed more strongly than other clinical prediction tools. In the subgroup of patients with coexistent pneumonia (n=299), 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.

  • Pulmonary disease
  • chronic obstructive
  • hospitalisation
  • hospital mortality
  • prognosis
  • COPD epidemiology
  • COPD exacerbations
  • emphysema
  • long-term oxygen therapy
  • lung physiology
  • non-invasive ventilation
  • respiratory muscles
  • sleep apnoea
  • systemic disease and lungs
  • allergic alveolitis
  • bronchiectasis
  • cystic fibrosis

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  • Funding The Breathe North Appeal and the Northumbria Healthcare NHS Foundation Trust Teaching and Research Fellow Programme.

  • Competing interests None.

  • Ethics approval Ethics approval was provided by the County Durham and Tees Valley NHS Research Ethics Committee II.

  • Provenance and peer review Not commissioned; externally peer reviewed.

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