Predictors of mortality in acute exacerbations of chronic obstructive pulmonary disease using the dyspnea, eosinopenia, consolidation, acidemia and atrial fibrillation score.

Background: Acute exacerbations of chronic obstructive pulmonary disease (AECOPD) are common and often fatal; however, accurate prognosis of patients hospitalized with an exacerbation is difficult. The Dyspnea, Eosinopenia, Consolidation, Acidemia, and Atrial Fibrillation (DECAF) score uses indices routinely available at the time of hospital admission and can accurately predict the inhospital mortality and outcomes in patients hospitalized with AECOPD.

Methodology: A cross-sectional study was conducted in Jawaharlal Nehru Medical College, Belagavi, from January 2016 to June 2018. Consecutive patients hospitalized with an exacerbation of chronic obstructive pulmonary disease were included. DECAF indices and inhospital death rates were recorded. The prognostic value of DECAF was assessed by comparing the total score with the inhospital mortality. Statistical analysis was done using SPSS version 20.

Results: Two hundred and twenty-eight patients were recruited. The mean (standard deviation) age was 61.09 ± 10.6 years; 73.68% were male and 48 patients (21.05%) died in hospital. One hundred and twelve patients were identified as low risk (DECAF: 0-1) with 6 (5.4%) patients dying in the hospital and 56 patients were identified as high risk (DECAF: 3-6) with an inhospital mortality of 60.1%. Length of stay for scores of 0-1, 2, and ≥3 was 6.42, 7.47, and 9.64 days, respectively, with P < 0.05. The receiver operating characteristic curve analysis showed P < 0.001, thereby proving that the DECAF is a significant predictor of mortality in AECOPD.

Conclusion: This study proved that with an increase in the DECAF score, the mortality among patients in AECOPD increased. The DECAF score helps clinicians predict prognosis accurately by identifying low-risk patients potentially suitable for home-based care or early hospital discharge and high-risk patients requiring escalated palliation with high-level care to improve their outcome.