A comparative study of DECAF score and modified DECAF score in predicting hospital mortality rates in acute exacerbation of chronic obstructive pulmonary disease

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Background Acute exacerbations of chronic obstructive pulmonary disease (AECOPD) are common and lead to catastrophic events. Accurate prognostic tool for patients with exacerbation who required hospital admission is needed to predict the risk of in-hospital mortality and help physicians to select the appropriate level of care. Aim The aim was to compare the ability of conventional DECAF (dyspnea, eosinopenia, consolidation, acidemia, frequency of hospital admission) and modified DECAF scores to expect the in-hospital mortality rate. Patients and methods A prospective, observational study was carried out on 100 patients with AECOPD admitted at the respiratory ICU and chest department. All patients were subjected to complete medical history taking, chest examination, dyspnea assessment by extended modified Medical Research Council Dyspnea, complete blood count, chest radiograph, ECG, and arterial blood gas analysis. Both conventional DECAF score [(D) dyspnea, (E) eosinopenia, (C) consolidation, (A) acidemia, (F) atrial fibrillation] and modified DECAF score [(D) dyspnea, (E) eosinopenia, (C) consolidation, (A) acidemia, (F) frequency of hospital admission] were calculated. In-hospital mortality was recorded. Results Nine (9%) patients died during their hospital stay. The modified DECAF score showed a good prediction of in-hospital mortality (area under the receiver operating characteristic curve=0.95) and was higher in accuracy than the original DECAF score (area under the receiver operating characteristic curve=0.92). Both were (sensitive 100%) but the modified DECAF was more specific (specificity=86.81) than the DECAF score (specificity=80.22). Conclusion Both the conventional DECAF score and the modified DECAF score are practical and can be calculated easily using simple questions and routine investigations available during the initial admission. Both were good predictors of mortality and the requirement of invasive mechanical ventilation. The modified DECAF was superior in predicting in-hospital mortality in AECOPD than the original score.