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Validation of the DECAF score to predict hospital mortality in acute exacerbations of COPD

Lookup NU author(s): Dr Carlos Echevarria, Dr John Steer, Dr Chris Stenton, Dr Ian Steen, Professor John SimpsonORCiD, Dr Grant Gibson, Professor Stephen BourkeORCiD



This work is licensed under a Creative Commons Attribution-NonCommercial 4.0 International License (CC BY-NC 4.0).


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.

Publication metadata

Author(s): Echevarria C, Steer J, Heslop-Marshall K, Stenton SC, Hickey PM, Hughes R, Wijesinghe M, Harrison RN, Steen N, Simpson AJ, Gibson GJ, Bourke SC

Publication type: Article

Publication status: Published

Journal: Thorax

Year: 2016

Volume: 71

Issue: 2

Pages: 133-140

Print publication date: 01/02/2016

Acceptance date: 10/11/2015

Date deposited: 06/05/2016

ISSN (print): 0040-6376

ISSN (electronic): 1468-3296

Publisher: BMJ Publishing Group


DOI: 10.1136/thoraxjnl-2015-207775


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Funder referenceFunder name
Breathe North appeal
NIHR Clinical Research Network
Northumbria NHS Foundation Trust Teaching and Research Fellowship programme
UK Department of Health
RES12-CO44Novartis pharmaceutical UK Limited