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

C Echevarria, J Steer, K Heslop-Marshall, S C Stenton, P M Hickey, R Hughes, M Wijesinghe, R N Harrison, N Steen, A J Simpson, G J Gibson, S C Bourke, C Echevarria, J Steer, K Heslop-Marshall, S C Stenton, P M Hickey, R Hughes, M Wijesinghe, R N Harrison, N Steen, A J Simpson, G J Gibson, S C Bourke

Abstract

Background: Hospitalisation 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.

Methods: The 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.

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) 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.

Conclusions: DECAF 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 number: UKCRN ID 14214.

Keywords: COPD Exacerbations.

Published by the BMJ Publishing Group Limited. For permission to use (where not already granted under a licence) please go to http://www.bmj.com/company/products-services/rights-and-licensing/

Figures

Figure 1
Figure 1
Receiver operator characteristic curves of prognostic scores for inhospital (A) and 30-day mortality (B).
Figure 2
Figure 2
Receiver operator characteristic curves of prognostic scores for 30-day mortality in patients with pneumonic exacerbations (n=489).
Figure 3
Figure 3
Inhospital mortality (percentage and absolute number) in the DECAF derivation and validation study, and ‘DECAF light’ (see discussion) from the 2014 UK National COPD Audit.

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