Predicting in-hospital mortality in acute exacerbation of COPD: Is there a golden score?

Background: Acute exacerbations of chronic obstructive pulmonary disease (AECOPD) impose a considerable burden of morbidity, mortality, and health care cost and frequently require hospital admission. Clinicians lack a validated tool for risk stratification of such admissions.Aim: To find the best prognostic score for prediction of in-hospital mortality due to AECOPD by comparing between the DECAF, the modified DECAF, the BAP-65 and the 2008 scores.Methods: 264 patients admitted to Chest Department, Menoufia University Hospitals for management of AECOPD were included; either retrospectively from January 2014 to February 2015 or prospectively from March to September 2015. The 4 scores were calculated for each of them.Results: Twenty patients (7.58%) died during their hospital stay. The non-surviving group had a statistically significant higher age, all were males and 19 of them were smokers. The DECAF score had an area under receiver-operating characteristic curve (AUROC) of 0.828, its sensitivity was 0.8, while its specificity was 0.623. The AUROC of the modified DECAF score was 0.774, its sensitivity and specificity were 0.8 and 0.443 respectively. The BAP score had the highest AUROC (0.861), its sensitivity and specificity were 0.8 and 0.951 respectively. The 2008 score had an AUROC of 0.774, its sensitivity and specificity were 1 and 0.279 respectively.Conclusion: BAP-score had higher AUROC and was more accurate in predicting in-hospital mortality than DECAF, modified DECAF and the 2008 scores