title: Validation of the DECAF score to predict hospital mortality in acute exacerbations of COPD.
abstract: BACKGROUND
  Hospitalisation due to acute exacerbations of COPD (AECOPD) is common, and subsequent mortality high. The DECAF score was derived for accurate prediction of mortality and risk stratification to inform patient care. We aimed to validate the DECAF score, internally and externally, and to compare its performance to other predictive tools.
  
  
  METHODS
  The study took place in the two hospitals within the derivation study (internal validation) and in four additional hospitals (external validation) between January 2012 and May 2014. Consecutive admissions were identified by screening admissions and searching coding records. Admission clinical data, including DECAF indices, and mortality were recorded. The prognostic value of DECAF and other scores were assessed by the area under the receiver operator characteristic (AUROC) curve.
  
  
  RESULTS
  In the internal and external validation cohorts, 880 and 845 patients were recruited. Mean age was 73.1 (SD 10.3) years, 54.3% were female, and mean (SD) FEV1 45.5 (18.3) per cent predicted. Overall mortality was 7.7%. The DECAF AUROC curve for inhospital mortality was 0.83 (95% CI 0.78 to 0.87) in the internal cohort and 0.82 (95% CI 0.77 to 0.87) in the external cohort, and was superior to other prognostic scores for inhospital or 30-day mortality.
  
  
  CONCLUSIONS
  DECAF is a robust predictor of mortality, using indices routinely available on admission. Its generalisability is supported by consistent strong performance; it can identify low-risk patients (DECAF 0-1) potentially suitable for Hospital at Home or early supported discharge services, and high-risk patients (DECAF 3-6) for escalation planning or appropriate early palliation.
  
  
  BACKGROUND
  UKCRN ID 14214.
authors.affiliation: Department of Respiratory Medicine, North Tyneside General Hospital, North Shields, UK Institute of Cellular Medicine, Newcastle University, Newcastle Upon Tyne, UK.
authors.forename: C
authors.initials: C
authors.lastname: Echevarria
authors.affiliation: Department of Respiratory Medicine, North Tyneside General Hospital, North Shields, UK.
authors.forename: J
authors.initials: J
authors.lastname: Steer
authors.affiliation: Institute of Cellular Medicine, Newcastle University, Newcastle Upon Tyne, UK Chest Clinic, Royal Victoria Infirmary, Newcastle Upon Tyne, UK.
authors.forename: K
authors.initials: K
authors.lastname: Heslop-Marshall
authors.affiliation: Chest Clinic, Royal Victoria Infirmary, Newcastle Upon Tyne, UK.
authors.forename: S C
authors.initials: SC
authors.lastname: Stenton
authors.affiliation: Department of Respiratory Medicine, Northern General Hospital, Sheffield, South Yorkshire, UK.
authors.forename: P M
authors.initials: PM
authors.lastname: Hickey
authors.affiliation: Department of Respiratory Medicine, Northern General Hospital, Sheffield, South Yorkshire, UK.
authors.forename: R
authors.initials: R
authors.lastname: Hughes
authors.affiliation: Department of Respiratory Medicine, Royal Cornwall Hospital, Truro, Cornwall, UK.
authors.forename: M
authors.initials: M
authors.lastname: Wijesinghe
authors.affiliation: Department of Respiratory Medicine, University Hospital of North Tees, Hardwick Hall, Stockton-on-Tees, Cleveland, UK.
authors.forename: R N
authors.initials: RN
authors.lastname: Harrison
authors.affiliation: Institute of Health and Society, Baddiley-Clark Building, Newcastle University, Newcastle Upon Tyne, UK.
authors.forename: N
authors.initials: N
authors.lastname: Steen
authors.affiliation: Institute of Cellular Medicine, Newcastle University, Newcastle Upon Tyne, UK.
authors.forename: A J
authors.initials: AJ
authors.lastname: Simpson
authors.affiliation: Institute of Cellular Medicine, Newcastle University, Newcastle Upon Tyne, UK.
authors.forename: G J
authors.initials: GJ
authors.lastname: Gibson
authors.affiliation: Department of Respiratory Medicine, North Tyneside General Hospital, North Shields, UK Institute of Cellular Medicine, Newcastle University, Newcastle Upon Tyne, UK.
authors.forename: S C
authors.initials: SC
authors.lastname: Bourke
mesh_terms: D000368:Aged; D018450:Disease Progression; D005260:Female; D005500:Follow-Up Studies; D017052:Hospital Mortality / Q000639:trends; D006801:Humans; D008297:Male; D011237:Predictive Value of Tests; D011379:Prognosis; D029424:Pulmonary Disease, Chronic Obstructive / Q000175:diagnosis* / Q000401:mortality; D012372:ROC Curve; D012189:Retrospective Studies; D018570:Risk Assessment; D012720:Severity of Illness Index; D013997:Time Factors; D006113:United Kingdom / Q000453:epidemiology
keywords: COPD Exacerbations