The v‐DECAF score can predict 90‐day all‐cause mortality in patients with COPD exacerbation requiring invasive mechanical ventilation

Abstract

Introduction The DECAF score is a simple and effective tool for predicting mortality in patients hospitalized with acute exacerbations of chronic obstructive pulmonary disease (AECOPD); however, the DECAF score has not been validated in AECOPD patients requiring invasive mechanical ventilation (IMV). We devised the ventilator (v)‐DECAF score, in which “anemia” replaces “acidaemia,” for use in AECOPD patients requiring IMV. The objective of this study was to compare the predictive efficacy of the v‐DECAF score and the DECAF score. Methods This study prospectively recruited 112 consecutive AECOPD patients requiring IMV from a single center. The clinical endpoint was 90‐day all‐cause mortality. Demographic and clinical data were recorded, as well as APACHE II, GCS, CURB‐65, BAP‐65 and DECAF scores, and the newly devised v‐DECAF score. The discriminatory value of the scoring systems in predicting 90‐day all‐cause mortality was determined using the area under the receiver operating characteristic (AUROC) curve. Results In multivariate logistic regression analysis, the v‐DECAF score was an independent predictor of 90‐day all‐cause mortality (odds ratio 3.004, 95% CI 1.658‐5.445, P < 0.001). The AUROC of the v‐DECAF and DECAF scores were 0.852 (95% CI 0.766‐0.938) and 0.777 (95%CI: 0.676‐0.878), respectively. The v‐DECAF score had a better predictive value for 90‐day all‐cause mortality compared to the DECAF score (Z = 2.338, P = 0.019). Conclusion The v‐DECAF score had good discriminatory power in predicting 90‐day all‐cause mortality in AECOPD patients requiring IMV.

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

“…Seventeen studies involving a total of 8329 participants met all of the criteria. 6 9 26–40 Among them, Echevarria et al 26 28 and Shi et al 27 29 each produced two articles from two different studies.…”

“…Among these studies, 15 reported the prognostic values of DECAF scores for in-hospital mortality 6 9 26 28 29 31–40 and five studies reported 30-day mortality. 27 28 30 31 33 The cut-off threshold for each study was retrospectively determined based on the ROC curve. For in-hospital mortality, the results of five studies were based on a cut-off value of 4, 9 28 35 37 39 four studies were based on a cut-off value of 3, 6 32 36 40 three studies were based on a cut-off value of 2 30 33 38 and the other three studies did not report a cut-off threshold.…”

Machine Learning Models to Predict 30-Day Mortality in Mechanically Ventilated Patients

“…As such, several mortality prediction models for mechanically ventilated patients have been suggested [ 4 , 7 , 8 , 9 , 10 , 11 ]. However, there are few models that are focused on predicting hospital mortality, and most models included only patients with pneumonia or chronic obstructive lung disease.…”

Predictors of Mortality in COPD&nbsp;Exacerbation Cases Presenting to the Respiratory Intensive Care Unit

“…Requirement for IMV was a signi cant predictor of in-hospital mortality of AECOPD. [21,24] In the Brown study, 38.7% of patients required IMV and multivariate analysis showed the requirement for IMV was importantly associated with in-hospital death. [21] Lindenauer PK et al showed that in-hospital mortality was higher in COPD patients who required IMV than in patients with non-invasive ventilation (NIV).…”