Introduction In patients presenting with an acute exacerbation of COPD (AECOPD), accurate prediction of in-hospital mortality may help inform the most appropriate place and level of care. The DECAF score was developed for this purpose and designed to be simple to apply at the bedside using variables that are routinely collected on admission: Dyspnoea, Eosinopenia, Consolidation, Acidaemia and atrial Fibrillation. Whilst the performance of the tool within the derivation cohort was strong,[1] before recommending use in clinical practice further validation is required.

Methods Both external and internal validation of the DECAF score are currently in progress; for each, a cohort of 840 patients consecutively admitted with AECOPD is being recruited. To optimise data capture, patients are identified by screening admissions units and coding records. Indices that comprise the DECAF score and other independent predictors of mortality and readmission are collected. Dyspnoea is assessed using the extended MRC dyspnoea score.[1] Inclusion criteria are: primary diagnosis of AECOPD, age 35 or older, 10 pack years or more smoking history, and obstructive spirometry. Exclusion criteria are: other illness likely to limit survival to less than one year (principally metastatic malignancy) and previous inclusion in the validation study. We present an analysis of the performance of DECAF in the first 623 patients recruited to the internal validation cohort.

Discussion As in the derivation study, DECAF is a good predictor of inpatient mortality (AUROC = 0.82), with a stepwise increase in mortality with DECAF score. The DECAF score accurately identifies low risk (DECAF score 0–1) and high risk patients (3 or greater) admitted with an exacerbation of COPD, potentially helping select patients for early supported discharge schemes, or for intensified medical treatment or early palliation.

References

1. Steer, J., J. Gibson, and S. C. Bourke, The DECAF Score: predicting hospital mortality in exacerbations of chronic obstructive pulmonary disease. Thorax, 2012. 67(11): p. 970–6.