A comparative evaluation of DECAF and modified DECAF scores for predicting outcomes in COPD exacerbations: A cross-sectional study

Chronic obstructive pulmonary disease (COPD) continues to pose a major global health burden, leading to high rates of illness and death across the world. The Dyspnoea, eosinopenia, consolidation, acidemia, atrial fibrillation (DECAF) score is an established prognostic tool in patients hospitalized for COPD. But a modified DECAF (mDECAF) score, in which atrial fibrillation is replaced by frequency of hospitalizations, has recently emerged as potentially more practical, especially in low-resource environments. This study aimed to evaluate the DECAF score as a prognostic indicator and compare its performance with the mDECAF score in predicting mortality, ventilatory support requirements, and hospital length of stay in patients with acute exacerbation of COPD.
A prospective hospital-based observational cross-sectional study was conducted over two years in the Department of Medicine at a tertiary care hospital in Wardha, Maharashtra, India. A total of 100 diagnosed COPD patients meeting inclusion criteria were enrolled. Detailed clinical evaluation, investigations, and application of DECAF and mDECAF scores were performed. Outcomes were recorded and analyzed.
Of the 100 patients, 72% were aged >60 years, and 61% were male. The mean±SD DECAF and mDECAF scores were 2.59 ± 1.66 and 2.71 ± 1.81, respectively. Overall mortality was 26%, 51% required ventilatory support, and the mean hospital stay was 4.47 ± 4.02 days. Patients who improved had significantly lower scores than those who died (DECAF: 1.97 ± 1.28 vs. 4.35 ± 1.35; mDECAF: 2.04 ± 1.44 vs. 4.62 ± 1.33; p < 0.001). Similarly, ventilated patients had higher scores than non-ventilated patients (DECAF: 3.59 ± 1.54 vs. 1.55 ± 1.04; mDECAF: 3.84 ± 1.67 vs. 1.53 ± 1.02; p < 0.001). Both DECAF and mDECAF showed strong correlations with hospital stay (r = 0.6 and 0.7, respectively; p < 0.001) and were strongly intercorrelated (rho = 0.96; p < 0.001). The area under the receiver operating characteristic curve (AUROC) for predicting mortality was 0.882 (95% CI: 0.800–0.964) for DECAF and 0.888 (95% CI: 0.819–0.957) for mDECAF (both p < 0.001). At a cutoff ≥4, DECAF predicted mortality with 81% sensitivity and 89% specificity, while mDECAF showed 77% sensitivity and 86% specificity.
Higher DECAF and mDECAF scores were significantly associated with increased mortality, need for ventilatory support, and longer hospital stay in patients with acute exacerbations of COPD, with both scores demonstrating excellent and comparable prognostic performance.