DECAF Score and BAP-65, the Tools for Prognosis in Acute Exacerbation of Chronic Obstructive Pulmonary Disease: A Prospective Observational Study

Abstract

Introduction: Acute Exacerbations of Chronic Obstructive Pulmonary Disease (AECOPD) result in significant morbidity and mortality. It is 3rd most common cause of death worldwide. Still, there is no proper prognostic scoring system available yet. The increasing mortality has been attributed to the smoking, epidemic and the advanced age of the world’s population. Exacerbations are uncommon in early COPD and are more common in moderate-to-severe disease. Aim: To validate and compare the Dyspnoea, Eosinopenia, Consolidation, Acidaemia, Atrial Fibrillation (DECAF) score and Blood Urea Nitrogen (BUN), Altered mental status, Pulse-age 65 (BAP-65) as tools of prognostication in AECOPD. Materials and Methods: A hospital-based prospective, observational study was conducted in the Department of General Medicine at Government Medical College Kota, Rajasthan, India. The duration of the study was two years, from December 2020 to December 2022. A total of 100 patients (84 males and 16 females), who were admitted with AECOPD were included. DECAF and BAP-65 scores, length of hospital stay, need for mechanical ventilation and mortality was recorded on a proforma and later analysed using Statistical Package for Social Sciences (SPSS) version 22.0. A Receiver Operating Characteristic (ROC) curve was drawn for comparison of the accuracy of both the scoring systems. Results: The mean age of the study participants was 64.91±11.78 years. Analysing the data statistically, the BAP65 class and DECAF score with mortality, need for mechanical ventilation, and duration of hospital stay showed a significant association. Comparing DECAF with BAP-65, DECAF showed higher predictive accuracy in mortality {Area Under Curve (AUC)- DECAF= 0.933 BAP-65-0.929) and duration of hospital stay (AUC-DECAF=0.753 BAP-65=0.929}) whereas, BAP-65 showed higher accuracy in predicting the need for mechanical ventilation (AUC-DECAF=0.851 BAP-65=0.916). Conclusion: Since, there was a good association between BAP-65 classes, as well as, the DECAF score and outcomes in AECOPD, these can be used as an assessment tool in predicting outcomes in patients presenting with AECOPD. It is better to use DECAF for predicting the length of hospital stay and mortality and BAP-65 for predicting the need for mechanical ventilation.

Keywords

• hospital stay
• mechanical ventilation
• mortality