RT Journal Article
SR Electronic
T1 Validation of the DECAF score to predict hospital mortality in acute exacerbations of COPD
JF Thorax
JO Thorax
FD BMJ Publishing Group Ltd and British Thoracic Society
SP 133
OP 140
DO 10.1136/thoraxjnl-2015-207775
VO 71
IS 2
A1 C Echevarria
A1 J Steer
A1 K Heslop-Marshall
A1 SC Stenton
A1 PM Hickey
A1 R Hughes
A1 M Wijesinghe
A1 RN Harrison
A1 N Steen
A1 AJ Simpson
A1 GJ Gibson
A1 SC Bourke
YR 2016
UL http://thorax.bmj.com/content/71/2/133.abstract
AB Background Hospitalisation due to acute exacerbations of COPD (AECOPD) is common, and subsequent mortality high. The DECAF score was derived for accurate prediction of mortality and risk stratification to inform patient care. We aimed to validate the DECAF score, internally and externally, and to compare its performance to other predictive tools.Methods The study took place in the two hospitals within the derivation study (internal validation) and in four additional hospitals (external validation) between January 2012 and May 2014. Consecutive admissions were identified by screening admissions and searching coding records. Admission clinical data, including DECAF indices, and mortality were recorded. The prognostic value of DECAF and other scores were assessed by the area under the receiver operator characteristic (AUROC) curve.Results In the internal and external validation cohorts, 880 and 845 patients were recruited. Mean age was 73.1 (SD 10.3) years, 54.3% were female, and mean (SD) FEV1 45.5 (18.3) per cent predicted. Overall mortality was 7.7%. The DECAF AUROC curve for inhospital mortality was 0.83 (95% CI 0.78 to 0.87) in the internal cohort and 0.82 (95% CI 0.77 to 0.87) in the external cohort, and was superior to other prognostic scores for inhospital or 30-day mortality.Conclusions DECAF is a robust predictor of mortality, using indices routinely available on admission. Its generalisability is supported by consistent strong performance; it can identify low-risk patients (DECAF 0–1) potentially suitable for Hospital at Home or early supported discharge services, and high-risk patients (DECAF 3–6) for escalation planning or appropriate early palliation.Trial registration number UKCRN ID 14214.