LATE-BREAKING ABSTRACT: Validation of the DECAF score to predict hospital mortality in exacerbations of COPD

Abstract

Background: Accurate prognostication and risk stratification in patients hospitalised due to acute exacerbations of chronic obstructive pulmonary disease (AECOPD) could improve patient care. The DECAF score accurately predicted mortality in its derivation cohort and the British Thoracic Society 2014 national audit recommended the score is collected on all patients admitted with AECOPD. We present the internal and external validation of the DECAF score to describe its performance in a diverse UK population. Methods: Six UK hospitals recruited consecutive admissions from January 2012-May 2014. Admission clinical data, including DECAF indices, and mortality were recorded. The prognostic value of DECAF, and other prognostic scores (APACHE II, BAP-65, CAPS, CURB-65), were assessed and compared by the area under the receiver operator characteristic (AUROC) curve. Results: In 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) % predicted. Overall mortality was 7.7%. The DECAF AUROC curve for in-hospital mortality was 0.83 (95% CI 0.78-0.87) in the internal cohort, 0.82 (95% CI 0.77-0.87) in the external cohort and superior to other prognostic scores for in-hospital or 30-day mortality. Conclusions: DECAF is simple to apply and a robust predictor of mortality. Its generalisability is supported by consistent strong performance in a diverse multicentre study. Its application could improve patient outcomes by identifying low risk patients potentially suitable for Hospital at Home or Early Supported Discharge services, and high risk patients for escalation planning or appropriate early palliation.