Evaluating the prognostic value of DECAF score and procalcitonin in patients with COPD exacerbation

Acute exacerbations of chronic obstructive pulmonary disease (AECOPD) frequently result in emergency department (ED) visits, necessitating accurate risk stratification. The aim of this study was to evaluate and compare the prognostic utility of the DECAF score and serum procalcitonin levels in predicting clinical outcomes in patients with AECOPD.

This retrospective cohort study encompassed AECOPD patients presenting to the ED over a three-year period who had serum procalcitonin levels measured. The primary outcome was one-month mortality, with secondary outcomes including ED re-admission, hospitalization, and intensive care unit (ICU) admission. Receiver operating characteristic (ROC) curve analysis was employed to assess the prognostic performance of DECAF score and procalcitonin, and differences between areas under the curve (AUC) were compared.

A total of 130 patients were analyzed, comprising 105 survivors and 25 non-survivors. The median DECAF score was significantly higher in non-survivors [4 (IQR: 3-4)] compared to survivors [3 (IQR: 2-4)] (p < 0.001). Similarly, median procalcitonin levels were elevated in non-survivors [0.26 ng/mL (IQR: 0.11-2.77)] relative to survivors [0.08 ng/mL (IQR: 0.04-0.21)] (p < 0.001). The AUC for the DECAF score was 0.758 (95 % CI: 0.673-0.842), while that for procalcitonin was 0.764 (95 % CI: 0.668-0.860). The difference between AUCs was 0.006 (95 % CI: -0.140 to 0.127), (p = 0.927). The negative predictive value (NPV) was 90.6 % for the 4-point DECAF score and 96.2 % for a 0.075 ng/mL procalcitonin cut-off. Notably, when used in combination, the NPV reached 100 % (95 % CI: 89.1-100).

The DECAF score and serum procalcitonin levels both exhibit robust prognostic capabilities in excluding adverse outcomes in AECOPD patients, with their predictive accuracy enhanced when used in tandem.