DECAF score as a mortality predictor for acute exacerbation of chronic obstructive pulmonary disease: a systematic review and meta-analysis

Abstract

Objectives: This study was conducted to assess the association between the Dyspnea, Eosinopenia, Consolidation, Acidemia and Atrial Fibrillation (DECAF) scores and the prognosis of patients with acute exacerbation of chronic obstructive pulmonary disease (AECOPD), to evaluate the specific predictive and prognostic value of DECAF scores and to explore the effectiveness of different cut-off values in risk stratification of patients with AECOPD.

Design: Systematic review and meta-analysis.

Participants: Adult patients diagnosed with AECOPD (over 18 years of age).

Primary and secondary outcome measures: Electronic databases, including the Cochrane Library, PubMed, the Embase and the WOS, and the reference lists in related articles were searched for studies published up to September 2019. The identified studies reported the prognostic value of DECAF scores in patients with AECOPD.

Results: Seventeen studies involving 8329 participants were included in the study. Quantitative analysis demonstrated that elevated DECAF scores were associated with high mortality risk (weighted mean difference=1.87; 95% CI 1.19 to 2.56). In the accuracy analysis, DECAF scores showed good prognostic accuracy for both in-hospital and 30-day mortality (area under the receiver operating characteristic curve: 0.83 (0.79-0.86) and 0.79 (0.76-0.83), respectively). When the prognostic value was compared with that of other scoring systems, DECAF scores showed better prognostic accuracy and stable clinical values than the modified DECAF; COPD and Asthma Physiology Score; BUN, Altered mental status, Pulse and age >65; Confusion, Urea, Respiratory Rate, Blood pressure and age >65; or Acute Physiology and Chronic Health Evaluation II scores.

Conclusion: The DECAF score is an effective and feasible predictor for short-term mortality. As a specific and easily scored predictor for patients with AECOPD, DECAF score is superior to other prognostic scores. The DECAF score can correctly identify most patients with AECOPD as low risk, and with the increase of cut-off value, the risk stratification of DECAF score in high-risk population increases significantly.

Keywords: adult intensive & critical care; chronic airways disease; respiratory medicine (see thoracic medicine).

Figure 1

Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) flow diagram and exclusion criteria.

Figure 2

Forest plot of sensitivity and specificity of Dyspnea, Eosinopenia, Consolidation, Acidemia and Atrial Fibrillation (DECAF) for the prediction of mortality in acute exacerbation of chronic obstructive pulmonary disease (AECOPD).

Figure 3

Hierarchical summary receiver operating characteristic curve for evaluating the prognostic value of mortality of Dyspnea, Eosinopenia, Consolidation, Acidemia and Atrial Fibrillation (DECAF) in acute exacerbation of chronic obstructive pulmonary disease (AECOPD). The HSROC, hierarchical summary receiver operating characteristic (HSROC) curve was conducted which plots sensitivity versus specificity. All studies were presented as a circle and plotted with the HSROC curve. The summary point (red box) indicates that the summary sensitivity was 0.76 and the summary specificity was 0.76. The summary results are displayed as the 95% confidence region and 95% prediction region in the HSROC curve plot. The size of the marker is scaled according to the total number of patients in each study.