Echevarria C, Steer J, Heslop-Marshall K, Stenton S C, Hickey P M, Hughes R, Wijesinghe M, Harrison R N, Steen N, Simpson A J, Gibson G J, Bourke S C
Department of Respiratory Medicine, North Tyneside General Hospital, North Shields, UK Institute of Cellular Medicine, Newcastle University, Newcastle Upon Tyne, UK.
Department of Respiratory Medicine, North Tyneside General Hospital, North Shields, UK.
Thorax. 2016 Feb;71(2):133-40. doi: 10.1136/thoraxjnl-2015-207775.
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.
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.
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) FEV1 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.
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.
UKCRN ID 14214.
慢性阻塞性肺疾病急性加重（AECOPD）导致的住院很常见，且随后的死亡率很高。DECAF评分用于准确预测死亡率和进行风险分层，以指导患者护理。我们旨在对DECAF评分进行内部和外部验证，并将其性能与其他预测工具进行比较。
该研究于2012年1月至2014年5月在推导研究中的两家医院（内部验证）和另外四家医院（外部验证）进行。通过筛查入院患者和搜索编码记录来确定连续入院患者。记录入院时的临床数据，包括DECAF指标和死亡率。通过受试者操作特征（AUROC）曲线下面积评估DECAF和其他评分的预后价值。
在内部和外部验证队列中，分别招募了880例和845例患者。平均年龄为73.1（标准差10.3）岁，54.3%为女性，预计平均（标准差）第1秒用力呼气容积（FEV1）为45.5（18.3）%。总体死亡率为7.7%。内部队列中，院内死亡率的DECAF AUROC曲线为0.83（95%置信区间0.78至0.87），外部队列为0.82（95%置信区间0.77至0.87），且在院内或30天死亡率方面优于其他预后评分。
DECAF是一种可靠的死亡率预测指标，使用入院时常规可得的指标。其良好的通用性得到了持续强劲表现的支持；它可以识别可能适合居家医院或早期支持出院服务的低风险患者（DECAF 0 - 1），以及适合升级护理计划或适当早期姑息治疗的高风险患者（DECAF 3 - 6）。
英国临床研究网络识别号14214。
