Comparing severity scores in exacerbations of chronic obstructive pulmonary disease

Prognostic scores help identify patients at a high risk of mortality in exacerbations of chronic obstructive pulmonary disease (COPD). The Dyspnoea, Eosinopaenia, Consolidation, Acidaemia and atrial Fibrillation (DECAF) score has been reported to perform better than other severity scores in predicting mortality from exacerbations of COPD in studies including patients with pneumonia.

To compare the performance of DECAF with other prognostic scores: CURB-65, CRB-65 and BAP-65, in predicting 30-day mortality in patients hospitalised with exacerbations of COPD without pneumonia.

Data from hospital admission of 423 patients from two cohorts of patients with exacerbations of COPD without consolidation on chest radiographs were used to compile the CURB-65, CRB-65, BAP-65 and DECAF scores. The performance of each prognostic score in predicting 30-day mortality was studied using receiver operating curve analysis.

Thirty-one patients (7%) died within 30 days of hospital admission. One hundred patients (24%) did not have DECAF scores because of the incomplete laboratory data, while all 423 patients had the other scores available for analysis. All scores predicted mortality with similar areas under the receiver operating characteristic curve (CURB-65 = 0.69, CRB-65 = 0.64, BAP-65 = 0.64, DECAF = 0.65, P = 0.186).

In patients hospitalised with exacerbations of COPD without pneumonia, simple clinical scores that rely on fewer laboratory measures perform at least as well as DECAF in predicting early mortality.