ICU, Lanzhou University First Affiliated Hospital, Lanzhou, Gansu, China.
The First Clinical Medical College, Lanzhou University, Lanzhou, Gansu, China.
BMJ Open. 2020 Oct 30;10(10):e037923. doi: 10.1136/bmjopen-2020-037923.
This study was conducted to assess the association between the Dyspnea, Eosinopenia, Consolidation, Acidemia and Atrial Fibrillation (DECAF) scores and the prognosis of patients with acute exacerbation of chronic obstructive pulmonary disease (AECOPD), to evaluate the specific predictive and prognostic value of DECAF scores and to explore the effectiveness of different cut-off values in risk stratification of patients with AECOPD.
Systematic review and meta-analysis.
Adult patients diagnosed with AECOPD (over 18 years of age).
Electronic databases, including the Cochrane Library, PubMed, the Embase and the WOS, and the reference lists in related articles were searched for studies published up to September 2019. The identified studies reported the prognostic value of DECAF scores in patients with AECOPD.
Seventeen studies involving 8329 participants were included in the study. Quantitative analysis demonstrated that elevated DECAF scores were associated with high mortality risk (weighted mean difference=1.87; 95% CI 1.19 to 2.56). In the accuracy analysis, DECAF scores showed good prognostic accuracy for both in-hospital and 30-day mortality (area under the receiver operating characteristic curve: 0.83 (0.79-0.86) and 0.79 (0.76-0.83), respectively). When the prognostic value was compared with that of other scoring systems, DECAF scores showed better prognostic accuracy and stable clinical values than the modified DECAF; COPD and Asthma Physiology Score; BUN, Altered mental status, Pulse and age >65; Confusion, Urea, Respiratory Rate, Blood pressure and age >65; or Acute Physiology and Chronic Health Evaluation II scores.
The DECAF score is an effective and feasible predictor for short-term mortality. As a specific and easily scored predictor for patients with AECOPD, DECAF score is superior to other prognostic scores. The DECAF score can correctly identify most patients with AECOPD as low risk, and with the increase of cut-off value, the risk stratification of DECAF score in high-risk population increases significantly.
本研究旨在评估呼吸困难、嗜酸性粒细胞减少、实变、酸中毒和心房颤动（DECAF）评分与慢性阻塞性肺疾病急性加重（AECOPD）患者预后之间的关系，评估 DECAF 评分的具体预测和预后价值，并探讨不同截断值在 AECOPD 患者风险分层中的有效性。
系统评价和荟萃分析。
诊断为 AECOPD 的成年患者（年龄＞18 岁）。
电子数据库，包括 Cochrane 图书馆、PubMed、Embase 和 WOS，以及相关文章的参考文献列表，检索截至 2019 年 9 月发表的研究。确定的研究报告了 DECAF 评分在 AECOPD 患者中的预后价值。
共纳入 17 项研究，涉及 8329 名参与者。定量分析表明，升高的 DECAF 评分与高死亡率风险相关（加权均数差=1.87；95%CI 1.19 至 2.56）。在准确性分析中，DECAF 评分对住院和 30 天死亡率均具有良好的预后准确性（受试者工作特征曲线下面积：0.83（0.79-0.86）和 0.79（0.76-0.83））。当将预后价值与其他评分系统进行比较时，DECAF 评分的预后准确性和稳定的临床价值均优于改良 DECAF、COPD 和哮喘生理学评分、BUN、精神状态改变、脉搏和年龄＞65 岁、意识模糊、尿素、呼吸频率、血压和年龄＞65 岁或急性生理学和慢性健康评估 II 评分。
DECAF 评分是短期死亡率的有效且可行的预测指标。作为一种针对 AECOPD 患者的有效且易于评分的预测指标，DECAF 评分优于其他预后评分。DECAF 评分可以正确识别大多数 AECOPD 患者为低风险，随着截断值的增加，DECAF 评分在高危人群中的风险分层显著增加。
