MDCalc

DECAF Score for Acute Exacerbation of COPD

Predicts in-hospital mortality in acute COPD exacerbation.

Use in patients ≥35 years old, hospitalized with a primary diagnosis of acute exacerbation of COPD. Do not use in patients with comorbidity expected to limit survival <12 months.

Extended MRC Dyspnea Scale (eMRCD)

On a good day, within the last 3 months

Eosinopenia

Eosinophils <0.05×10⁹/L

Consolidation on chest x-ray

Acidemia

pH <7.30

Atrial fibrillation

On EKG at presentation and/or history of paroxysmal afib

Result:

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Advice
  • Increasing DECAF Scores correlate with increased risk for in-hospital mortality.
  • High risk DECAF Scores (3-6) are associated with both high risk of death and short time to death. Consider early escalation and higher level of monitoring versus palliative care for these patients.
  • Low risk DECAF Scores (0-1) are associated with low mortality risk and these patients may be candidates for early discharge.
Management

Was not studied to dictate management or treatment options. The score should not replace clinical judgment regarding workup, diagnosis, or treatment.

Critical Actions
  • Should only be used in admitted patients with a primary diagnosis of an acute COPD exacerbation, not in the outpatient setting or in patients whose COPD is stable.
  • DECAF Scores 5–6 were found to have highest risk of death and shortest time to death, and may warrant early evaluation for escalation of care, higher level of monitoring, or potential palliative care.
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