Prognostic Accuracy of DECAF and Ottawa COPD Risk Scores in Patients Presenting to the Emergency Department With COPD Exacerbation.

Abstract

Background: Acute exacerbation of chronic obstructive pulmonary disease (COPD) constitutes an important part of emergency department (ED) admissions. Therefore, risk scores for evaluating prognosis in COPD patients are valuable. The study aimed to determine the prognostic accuracy of Dyspnea, Eosinopenia, Consolidation, Acidemia, and Atrial Fibrillation (DECAF) and Ottawa COPD Risk Scale in predicting short-term outcomes in patients presenting to the ED with COPD exacerbation.

Methods: This was a prospective cohort study conducted in a tertiary care hospital. All adult patients who presented to the ED with COPD exacerbation between June 2021 and June 2022 were included. DECAF and Ottawa COPD risk scores were calculated for each patient at ED admission. The primary outcome was all-cause mortality within 30 days of discharge.

Results: The data of 137 patients were analyzed. At the end of the 30-day period, 16 (11.7%) patients died, and 11 (8.0%) were admitted to the ICU. Based on receiver operating characteristic (ROC) curves plotted for mortality, the area under the curve (AUC) for the DECAF score was 0.762 (95% confidence interval [CI]: 0.649-0.876, p = 0.001), while the AUC for the Ottawa score was 0.796 (95% CI: 0.704-0.888, p < 0.001). The scores did not differ for mortality estimation ( p = 0.626). Using a score cut-off value of 3 for both scores for mortality outcome, the sensitivity/specificity values were 63%/78% for DECAF and 100%/34% for Ottawa.

Conclusion: Both risk scores are useful tools for predicting short-term outcomes in patients presenting to the ED after COPD exacerbation and can be used for risk management in the ED.