Validation of the DECAF score to predict hospital mortality in acute exacerbations of COPD

Abstract

BackgroundHospitalisation 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.MethodsThe 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.ResultsIn 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.ConclusionsDECAF 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 numberUKCRN ID 14214.

Caring about what happens to people with COPD

“…The initial derivation and subsequent validation cohorts, including six UK centres, were those that were also used in the development of the Dyspnoea, Eosinopenia, Consolidation, Acidaemia, and atrial Fibrillation (DECAF) score, a tool to identify patients who can be safely discharged 4 5. Patient characteristics, selected on the basis of literature review and clinical plausibility, and which were consistently recorded across sites, were related to the risk of readmission or death within 90 days of discharge.…”

“…At 30 days, readmission or death occurred in 11%, 24% and 40%, respectively. The performance of the PEARL score was compared with other predictive scores (age dyspnoea obstruction index (ADO)6 DECAF, eMRCD4 5 BODEX7 CODEX8 dyspnoea, obstruction, smoking, exacerbations index (DOSE)9 and LACE10). The area under the receiver-operating characteristic curve (AUROC) for PEARL in the validation cohort was 0.7, superior to all other prognostic scores tested.…”

A risk stratification tool for exacerbations of COPD: time to switch to DECAF

“…A clinical prognostic tool requires robust validation in an independent group of patients and in their current paper, Echevarria and colleagues have performed a validation of the DECAF score 3. A new cohort of 880 patients from the original two hospitals and an independent cohort of 845 patients who were admitted with an exacerbation of COPD to four additional hospitals were included, giving a total cohort of 1725.…”

The DECAF Score is a Superior Predictor of In-hospital Death than the BAP-65 Score

“…In fact, there are multiple tools that perform well in this population, though DECAF has been shown to be superior to alternatives [4]. This is important to acknowledge, as readers are left with the impression that clinicians must rely on judgment alone, which is less accurate than using clinical tools [6].…”

“…However, DECAF showed consistent and excellent discrimination in the derivation and validation studies (area under the receiver operator characteristic (AUROC) curve 0.86 and 0.83 respectively) [3,4] and outperformed BAP-65, which performed inconsistently (AUROC 0.65 and 0.77 respectively). One potential weakness of BAP-65 is that the assessment of mental status may vary, despite their claim that the BAP-65 indices are objective.…”