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Huang Q, He C, Xiong H, Shuai T, Zhang C, Zhang M, Wang Y, Zhu L, Lu J, Jian L. DECAF score as a mortality predictor for acute exacerbation of chronic obstructive pulmonary disease: a systematic review and meta-analysis. BMJ Open 2020; 10:e037923. [PMID: 33127631 PMCID: PMC7604856 DOI: 10.1136/bmjopen-2020-037923] [Citation(s) in RCA: 11] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/18/2022] Open
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.
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Affiliation(s)
- Qiangru Huang
- ICU, Lanzhou University First Affiliated Hospital, Lanzhou, Gansu, China
- The First Clinical Medical College, Lanzhou University, Lanzhou, Gansu, China
| | - Chengying He
- ICU, Lanzhou University First Affiliated Hospital, Lanzhou, Gansu, China
- The First Clinical Medical College, Lanzhou University, Lanzhou, Gansu, China
| | - Huaiyu Xiong
- ICU, Lanzhou University First Affiliated Hospital, Lanzhou, Gansu, China
- The First Clinical Medical College, Lanzhou University, Lanzhou, Gansu, China
| | - Tiankui Shuai
- ICU, Lanzhou University First Affiliated Hospital, Lanzhou, Gansu, China
- The First Clinical Medical College, Lanzhou University, Lanzhou, Gansu, China
| | - Chuchu Zhang
- ICU, Lanzhou University First Affiliated Hospital, Lanzhou, Gansu, China
- The First Clinical Medical College, Lanzhou University, Lanzhou, Gansu, China
| | - Meng Zhang
- ICU, Lanzhou University First Affiliated Hospital, Lanzhou, Gansu, China
- The First Clinical Medical College, Lanzhou University, Lanzhou, Gansu, China
| | - Yalei Wang
- ICU, Lanzhou University First Affiliated Hospital, Lanzhou, Gansu, China
- The First Clinical Medical College, Lanzhou University, Lanzhou, Gansu, China
| | - Lei Zhu
- ICU, Lanzhou University First Affiliated Hospital, Lanzhou, Gansu, China
- The First Clinical Medical College, Lanzhou University, Lanzhou, Gansu, China
| | - Jiaju Lu
- ICU, Lanzhou University First Affiliated Hospital, Lanzhou, Gansu, China
- The First Clinical Medical College, Lanzhou University, Lanzhou, Gansu, China
| | - Liu Jian
- ICU, Lanzhou University First Affiliated Hospital, Lanzhou, Gansu, China
- The First Clinical Medical College, Lanzhou University, Lanzhou, Gansu, China
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Shi QF, Sheng Y, Zhu N, Tan Y, Xie XH, Wang SY, Cai JF. The v-DECAF score can predict 90-day all-cause mortality in patients with COPD exacerbation requiring invasive mechanical ventilation. CLINICAL RESPIRATORY JOURNAL 2019; 13:438-445. [PMID: 30955228 DOI: 10.1111/crj.13028] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 06/20/2018] [Revised: 03/06/2019] [Accepted: 03/31/2019] [Indexed: 11/28/2022]
Abstract
INTRODUCTION The DECAF score is a simple and effective tool for predicting mortality in patients hospitalized with acute exacerbations of chronic obstructive pulmonary disease (AECOPD); however, the DECAF score has not been validated in AECOPD patients requiring invasive mechanical ventilation (IMV). We devised the ventilator (v)-DECAF score, in which "anemia" replaces "acidaemia," for use in AECOPD patients requiring IMV. The objective of this study was to compare the predictive efficacy of the v-DECAF score and the DECAF score. METHODS This study prospectively recruited 112 consecutive AECOPD patients requiring IMV from a single center. The clinical endpoint was 90-day all-cause mortality. Demographic and clinical data were recorded, as well as APACHE II, GCS, CURB-65, BAP-65 and DECAF scores, and the newly devised v-DECAF score. The discriminatory value of the scoring systems in predicting 90-day all-cause mortality was determined using the area under the receiver operating characteristic (AUROC) curve. RESULTS In multivariate logistic regression analysis, the v-DECAF score was an independent predictor of 90-day all-cause mortality (odds ratio 3.004, 95% CI 1.658-5.445, P < 0.001). The AUROC of the v-DECAF and DECAF scores were 0.852 (95% CI 0.766-0.938) and 0.777 (95%CI: 0.676-0.878), respectively. The v-DECAF score had a better predictive value for 90-day all-cause mortality compared to the DECAF score (Z = 2.338, P = 0.019). CONCLUSION The v-DECAF score had good discriminatory power in predicting 90-day all-cause mortality in AECOPD patients requiring IMV.
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Affiliation(s)
- Qi-Fang Shi
- Department of Emergency and Critical Care Medicine Shanghai Pudong Hospital, Fudan University Pudong Medical Center, Pudong, China
| | - Ying Sheng
- Department of Emergency and Critical Care Medicine Shanghai Pudong Hospital, Fudan University Pudong Medical Center, Pudong, China
| | - Nian Zhu
- Department of Emergency and Critical Care Medicine Shanghai Pudong Hospital, Fudan University Pudong Medical Center, Pudong, China
| | - Yan Tan
- Department of Emergency and Critical Care Medicine Shanghai Pudong Hospital, Fudan University Pudong Medical Center, Pudong, China
| | - Xiao-Hong Xie
- Department of Emergency and Critical Care Medicine Shanghai Pudong Hospital, Fudan University Pudong Medical Center, Pudong, China
| | - Shu-Yun Wang
- Department of Emergency and Critical Care Medicine Shanghai Pudong Hospital, Fudan University Pudong Medical Center, Pudong, China
| | - Jin-Fang Cai
- Department of Emergency and Critical Care Medicine Shanghai Pudong Hospital, Fudan University Pudong Medical Center, Pudong, China
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