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Validation of the DECAF score to predict hospital mortality in acute exacerbations of COPD
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 c...
Autores principales: | , , , , , , , , , , , |
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Formato: | Online Artículo Texto |
Lenguaje: | English |
Publicado: |
BMJ Publishing Group
2016
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Materias: | |
Acceso en línea: | https://www.ncbi.nlm.nih.gov/pmc/articles/PMC4752621/ https://www.ncbi.nlm.nih.gov/pubmed/26769015 http://dx.doi.org/10.1136/thoraxjnl-2015-207775 |
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author | 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 |
author_facet | 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 |
author_sort | Echevarria, C |
collection | PubMed |
description | 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) FEV(1) 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. TRIAL REGISTRATION NUMBER: UKCRN ID 14214. |
format | Online Article Text |
id | pubmed-4752621 |
institution | National Center for Biotechnology Information |
language | English |
publishDate | 2016 |
publisher | BMJ Publishing Group |
record_format | MEDLINE/PubMed |
spelling | pubmed-47526212016-02-21 Validation of the DECAF score to predict hospital mortality in acute exacerbations of COPD 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 Thorax Chronic Obstructive Pulmonary Disease 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) FEV(1) 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. TRIAL REGISTRATION NUMBER: UKCRN ID 14214. BMJ Publishing Group 2016-02 /pmc/articles/PMC4752621/ /pubmed/26769015 http://dx.doi.org/10.1136/thoraxjnl-2015-207775 Text en Published by the BMJ Publishing Group Limited. For permission to use (where not already granted under a licence) please go to http://www.bmj.com/company/products-services/rights-and-licensing/ This is an Open Access article distributed in accordance with the Creative Commons Attribution Non Commercial (CC BY-NC 4.0) license, which permits others to distribute, remix, adapt, build upon this work non-commercially, and license their derivative works on different terms, provided the original work is properly cited and the use is non-commercial. See: http://creativecommons.org/licenses/by-nc/4.0/ |
spellingShingle | Chronic Obstructive Pulmonary Disease 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 Validation of the DECAF score to predict hospital mortality in acute exacerbations of COPD |
title | Validation of the DECAF score to predict hospital mortality in acute exacerbations of COPD |
title_full | Validation of the DECAF score to predict hospital mortality in acute exacerbations of COPD |
title_fullStr | Validation of the DECAF score to predict hospital mortality in acute exacerbations of COPD |
title_full_unstemmed | Validation of the DECAF score to predict hospital mortality in acute exacerbations of COPD |
title_short | Validation of the DECAF score to predict hospital mortality in acute exacerbations of COPD |
title_sort | validation of the decaf score to predict hospital mortality in acute exacerbations of copd |
topic | Chronic Obstructive Pulmonary Disease |
url | https://www.ncbi.nlm.nih.gov/pmc/articles/PMC4752621/ https://www.ncbi.nlm.nih.gov/pubmed/26769015 http://dx.doi.org/10.1136/thoraxjnl-2015-207775 |
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