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Exacerbation of COPD | DECAF Score for Predicting Hospital Mortality

Purpose: To predict mortality for a patient admitted to the hospital with an exacerbation of COPD based on the DECAF score of Steer et al.

Description

Steer et al reported the DECAF score for evaluating a patient hospitalized for an exacerbation of chronic obstructive pulmonary disease (COPD). This is based on the 5 strongest predictors of mortality. The authors are from North Tyneside General Hospital and Newcastle University in England.


Patient selection: adult admitted with an acute exacerbation of COPD

 

Parameters of DECAF score:

(1) dyspnea (D) by the extended MRCD scale

(2) eosinopenia (E)

(3) consolidation (C) with new infiltrate on chest X-ray

(4) acidosis (A) based on arterial pH

(5) atrial fibrillation (F)

 

Parameter

Finding

Points

dyspnea

not homebound

0

 

homebound, independent in ADL (eMRCD 5a)

1

 

homebound, dependent in ADL (eMRCD 5b)

2

eosinophil count

>= 50 per µL

0

 

< 50 per µL

1

consolidation

absent

0

 

present

1

arterial pH

>= 7.3

0

 

< 7.3

1

atrial fibrillation

absent

0

 

present

1

 

total DECAF score =

= SUM(points for all 5 parameters)

 

Interpretation:

• minimum score: 0

• maximum score: 6

• The higher the score the greater the in-hospital mortality.

 

DECAF Score

In-Hospital Mortality

30-Day Mortality

0

0.5%

1.5%

1

2%

4%

2

8%

12%

3

24%

27%

4

46%

46%

5

70%

70%

6

> 70%

> 70%

 

Performance:

• The area under the ROC curve is 0.86.


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Specialty

Objective

ICD-10