Role of the DECAF Score in Predicting In-hospital Mortality in Acute Exacerbation of Chronic Obstructive Pulmonary Disease

Memon, Mubeen; Faryal, Sheeba; Brohi, Naveed; Kumar, Besham

doi:10.7759/cureus.4826

Cited by 10 publications

(11 citation statements)

References 13 publications

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“… 6 In clinical practice, test with AUC greater than 0.8 is considered to be very reliable. 22 The results showed that the AUC of the DECAF scores was 0.83 for predicting in-hospital mortality and 0.79 for short-term mortality (30 days). This indicates that the DECAF test can be used as a promising prognosis tool with satisfactory SEN and SPE for patients with AECOPD.…”

Section: Discussionmentioning

confidence: 95%

DECAF score as a mortality predictor for acute exacerbation of chronic obstructive pulmonary disease: a systematic review and meta-analysis

Huang

Xiong

et al. 2020

BMJ Open

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ObjectivesThis study was conducted to assess the association between the Dyspnea, Eosinopenia, Consolidation, Acidemia and Atrial Fibrillation (DECAF) scores and the prognosis of patients with acute exacerbation of chronic obstructive pulmonary disease (AECOPD), to evaluate the specific predictive and prognostic value of DECAF scores and to explore the effectiveness of different cut-off values in risk stratification of patients with AECOPD.DesignSystematic review and meta-analysis.ParticipantsAdult patients diagnosed with AECOPD (over 18 years of age).Primary and secondary outcome measuresElectronic databases, including the Cochrane Library, PubMed, the Embase and the WOS, and the reference lists in related articles were searched for studies published up to September 2019. The identified studies reported the prognostic value of DECAF scores in patients with AECOPD.ResultsSeventeen studies involving 8329 participants were included in the study. Quantitative analysis demonstrated that elevated DECAF scores were associated with high mortality risk (weighted mean difference=1.87; 95% CI 1.19 to 2.56). In the accuracy analysis, DECAF scores showed good prognostic accuracy for both in-hospital and 30-day mortality (area under the receiver operating characteristic curve: 0.83 (0.79–0.86) and 0.79 (0.76–0.83), respectively). When the prognostic value was compared with that of other scoring systems, DECAF scores showed better prognostic accuracy and stable clinical values than the modified DECAF; COPD and Asthma Physiology Score; BUN, Altered mental status, Pulse and age >65; Confusion, Urea, Respiratory Rate, Blood pressure and age >65; or Acute Physiology and Chronic Health Evaluation II scores.ConclusionThe DECAF score is an effective and feasible predictor for short-term mortality. As a specific and easily scored predictor for patients with AECOPD, DECAF score is superior to other prognostic scores. The DECAF score can correctly identify most patients with AECOPD as low risk, and with the increase of cut-off value, the risk stratification of DECAF score in high-risk population increases significantly.

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Section: Discussionmentioning

confidence: 95%

DECAF score as a mortality predictor for acute exacerbation of chronic obstructive pulmonary disease: a systematic review and meta-analysis

Huang

Xiong

et al. 2020

BMJ Open

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“…A recent study found that patients with a DECAF score of four or more are at high risk of mortality. 6 Based on the DECAF score, we ranked participants at four levels: ≤2, 3, 4, and ≥5.…”

Section: Methodsmentioning

confidence: 99%

A Frailty Assessment Tool to Predict In-Hospital Mortality in Patients with Acute Exacerbations of Chronic Obstructive Pulmonary Disease

Gu¹,

Liu²,

Zheng³

2021

COPD

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Background The exacerbation of chronic obstructive pulmonary disease (AECOPD) is a chronic, frequent, and life-threatening lung disease. In 2014, a frailty index (FI) based on deficits in commonly used laboratory tests (FI-Lab) was suggested to identify older adults at increased risk of death. Objective We aim to study the prognostic value of the FI-Lab in older Chinese patients who were admitted because of AECOPD. Methods We screened 1932 older patients hospitalized with AECOPD from September 2016 to June 2019 at Zhenjiang First People’s Hospital, China. A multivariate logistic regression analysis was used to identify prognostic factors for in-hospital mortality. Results A total of 77 survivors and 77 non-survivors were finally included in the study. Both the mean DECAF (including dyspnea, eosinopenia, consolidation, acidemia, and atrial fibrillation) score and the mean FI-Lab value of non-survivors were statistically higher than those of survivors (4.45 ± 0.80 versus 3.03 ± 0.90, P =0.000; 0.51 ± 0.13 versus 0.29 ± 0.10, P =0.000, respectively). Logistic regression analysis suggested that DECAF Rank and FI-Lab Rank were strongly related factors of death in AECOPD patients. The areas under the receiver-operating characteristic (ROC) curves were 0.906 for FI-Lab and 0.870 for DECAF ( P =0.2991). Conclusion FI-Lab is a simple, efficient, and objective tool to stratify the risk of in-hospital mortality of AECOPD.

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“…A higher score indicates poorer condition. A recent study reported that patients with a DECAF score of four or higher have a signi cant risk of mortality [6].Based on DECAF score we categorized the participants into four grades:≤2, 3, 4, and ≥5.…”

Section: Decaf Scorementioning

confidence: 99%

“…Assessing in-hospital mortality risk rapidly and accurately by a simple prognostic marker will be helpful in grading nursing care and allocating medical resources. Current prognostic markers about AECOPD include two main categories: in ammation-related makers [2][3][4] and DECAF score [5][6][7]. In ammatory mediators can destroy lung structure and promote neutrophil-related in ammation, which can aggravate the disease and cause death.…”

Section: Introductionmentioning

confidence: 99%

A new tool for predicting in-hospital mortality in Chinese older patients with exacerbation of chronic obstructive pulmonary disease(AECOPD): frailty index based on common laboratory tests (FI-Lab)

Gu¹,

Zheng²,

Liu³

2020

Preprint

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Introduction: The exacerbation of chronic obstructive pulmonary disease(AECOPD)is a common and fetal disease but with no ideal predictor of in-hospital mortality. Frailty prevails in older adults with AECOPD and can cause increased vulnerability to many adverse health outcomes including death. However, we know little about how frailty affects in-hospital mortality in older AECOPD patients. Objective: To explore the predictive validity of FI-Lab—an objective tool for assessing frailty including 21 routine blood tests plus systolic and diastolic blood pressure (a score between 0 and 1, a higher score indicates greater frailty)—for in-hospital mortality in patients with AECOPD. Methods: We reviewed the hospitalization records of older AECOPD inpatients from September 2016 to June 2019 at Zhenjiang First People's Hospital. We compared survivors to non-survivors. We used propensity score matching (PSM) to balance priori differences between survivors and non-survivors. Logistic regression analysis was used to select the associated predictors of in-hospital mortality. Receiver-operating characteristic (ROC) curves were calculated to estimate the area under the ROC curve (AUCs) for FI-Lab and DECAF(a commonly used predictor of AECOPD including dyspnea, eosinophilia, pulmonary consolidation, acidemia, and atrial fibrillation; a score between 1and 6; a higher score indicates poorer condition)in relation to mortality. Data were analyzed using IBM SPSS for Windows, Version 23.0. Results: A total of 154 patients—77 survivors and 77 non-survivors—were included in the study finally. The mean age of these patients was 79.73 ± 8.38 years. Both of the mean DECAF score, the mean FI-Lab value of non-survivors were statistically higher than those of survivors(4.45 ± 0.80 versus 3.03 ± 0.90,P = 0.000; 0.51 ± 0.13 versus 0.29 ± 0.10,P = 0.000,respectively). Logistic regression analysis suggested that high DECAF grade and high FI-Lab grade were strong related factors of death in AECOPD patients (OR:5.620, 95%CI 2.811–11.236, P = 0.000; OR:8.705, 95%CI 3.646–20.782, P = 0.000, respectively). The DECAF scores of most non-survivors were ≥ 4༈n = 71,92.21%༉. FI-Lab value predicted in-hospital mortality at a cut-off value of 0.4388 with 70.1% sensitivity, 96.1% specificity, 0.675 Youden index. DECAF score predicted in-hospital mortality at a cut-off value of 3.5 with 92.2% sensitivity, 72.7% specificity, 0.649 Youden index. The areas under the ROC curves were 0.906 for FI-Lab and 0.870 for DECAF with no statistically significant༈P = 0.2991). Conclusions: FI-Lab has a slightly stronger screening ability than DECAF. FI-Lab is a simple, effective and objective indicator and can be quick to help clinicians to assess in-hospital mortality of AECOPD patients.

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Role of the DECAF Score in Predicting In-hospital Mortality in Acute Exacerbation of Chronic Obstructive Pulmonary Disease

Cited by 10 publications

References 13 publications

DECAF score as a mortality predictor for acute exacerbation of chronic obstructive pulmonary disease: a systematic review and meta-analysis

DECAF score as a mortality predictor for acute exacerbation of chronic obstructive pulmonary disease: a systematic review and meta-analysis

A Frailty Assessment Tool to Predict In-Hospital Mortality in Patients with Acute Exacerbations of Chronic Obstructive Pulmonary Disease

A new tool for predicting in-hospital mortality in Chinese older patients with exacerbation of chronic obstructive pulmonary disease(AECOPD): frailty index based on common laboratory tests (FI-Lab)

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