Comparison of dyspnea, acidosis, consolidation, acidaemia, and atrial fibrillation score and BAP-65 score as tools for prediction of mortality and morbidity in acute exacerbations of chronic obstructive pulmonary disease at a tertiary care hospital

Abstract

Background: According to the Global Burden of Disease 2018, chronic obstructive pulmonary disease (COPD) is the third-leading cause of death worldwide and in India COPD is the second leading cause of death among noncommunicable diseases. Tools to predict mortality in stable COPD are widely in use but there has been lack of research into exacerbations and finding an appropriate clinical tool could help to reduce morbidity and mortality in these cases. Aims: 1. To assess dyspnea, acidosis, consolidation, acidaemia, and atrial fibrillation (DECAF) score and Blood Urea Nitrogen, altered mental status, pulse > 109 beats/min, age > 65 years (BAP- 65) score in acute exacerbations of COPD. 2. To compare the DECAF score and BAP-65 score as predictors of in-hospital morbidity and mortality. Subjects and Methods: The study was a prospective observational study carried out on 80 patients with acute exacerbation of COPD admitted to Bangalore Medical College and Research Institute from November 2018 to May 2020. Detailed history, physical examination, and standard laboratory tests were done on admission. Patients were assessed by the DECAF and BAP-65 (blood urea nitrogen, altered mental status, pulse, age ≥65 years) scores. The outcomes in terms of mortality and need for mechanical ventilation were studied and comparisons were drawn between the two scores. Results: From 80 AECOPD patients, 8 patients died and 72 survived. Significant difference was found in dyspnea grade eMRCD 5b (P = 0.038), eosinopenia (P = 0.036), pH <7.3 (P < 0.001), and consolidation (P = 0.027) between survivors and patients who died. With the rise in total DECAF score mortality rose (P < 0.001). When the individual components of the BAP-65 score were compared there was no statistically significant difference. With rise in the total BAP-65 score, there was no significant difference in mortality (P = 0.09). Sensitivity for prediction of mortality for DECAF score and BAP-65 score was 88.9% and 81.7%, respectively, and specificity was 55.4% and 63.4% respectively. Sensitivity for prediction of need for mechanical ventilation for DECAF score and BAP-65 score was 83.3% and 83.8%, respectively, and specificity was 66.7% and 66.2%, respectively. Conclusions: In our study, we found the DECAF score to be a better predictor of mortality and need for mechanical ventilation than the BAP-65 score as it is a composite score taking into account various parameters such as acidosis, consolidation on imaging, and eosinopenia each of which are individually strong predictors of mortality.

Keywords

• acidaemia and atrial fibrillation score
• acidosis
• chronic obstructive pulmonary disease
• consolidation
• dyspnea
• exacerbation
• mortality