Comparison of BAP65, DECAF, PEARL and MEWS Scores in Predicting Respiratory Support Need in Hospitalized ECOPD Patients

Abstract

OObjective: Prognostic models aid clinical practice with decision-making on treatment and hospitalization in exacerbation of chronic obstructive lung disease (ECOPD). Although there are many studies with prognostic models, diagnostic accuracy is variable within and between models. Subjects and Methods: We compared prognostic performance of the BAP65 score, DECAF score, PEARL score and modified early warning score (MEWS) in hospitalized patients with ECOPD, to estimate ventilatory support need. Results: This cross-sectional study consisted of 139 patients. Patients in need of non-invasive or invasive mechanical ventilation support are grouped as ventilatory support group (n = 54). Comparison between receiver operating characteristic (ROC) curves revealed that the DECAF score is significantly superior to the PEARL score (p = 0.04) in discriminating patients in need of ventilatory support. DECAF score with a cut-off value of 1 presented the highest sensitivity and BAP65 score with a cut-of value of 2 presented the highest specificity in predicting ventilatory support need. Multivariable analysis revealed gender played a significant role in COPD exacerbation outcome and arterial pCO2 and RDW measurements were also predictors of ventilatory support need. Within severity indexes, only the DECAF score was independently associated with the outcome. One point increase in DECAF score created a 1.43 times higher risk of ventilatory support need. All severity indexes showed correlation with age, comorbidity index and dyspnea. BAP65 and DECAF scores also showed correlation with length of stay. Conclusion: Objective and practical classifications are needed by clinicians to assess prognosis and initiate treatment accordingly. DECAF score is a strong candidate among severity indexes.