Ocrs, Decaf, and Bap-65 Scores for Predicting the Outcomes of Acute Copd Exacerbation: A Prognostic Accuracy Study Publisher



Rousta AM ; Safari S ; Ranjbar MF ; Aghili SH
Source: Journal of Emergency Practice and Trauma Published:2024

Abstract

Objective: Acute exacerbation of chronic obstructive pulmonary disease (COPD) is a significant healthcare burden. This study aimed to compare three risk assessment tools in predicting the outcomes of COPD exacerbation. Methods: This prospective cohort study was conducted between October 2023 and November 2024 at five hospitals in Iran (three in Tehran, one in Shahr-e-Rey, and one in Nehbandan). A total of 392 patients admitted with acute exacerbation of COPD were enrolled using consecutive sampling. The predictive accuracy of the Ottawa COPD Risk Scale (OCRS), DECAF, and BAP-65 for adverse outcomes (ICU admission, mechanical ventilation, and mortality) was assessed. The area under the receiver operating characteristic curve (AUC-ROC) and performance metrics (sensitivity, specificity, predictive values, and likelihood ratios) were calculated for each score. AUCs were compared using paired sample ROC analysis with significance set at P< 0.05. Results: The AUCs for OCRS, DECAF, and BAP-65 in predicting cumulative adverse outcomes (CAO) were 0.78 (95% CI: 0.73–0.83), 0.79 (95% CI: 0.74–0.83), and 0.79 (95% CI: 0.74–0.83), respectively (P< 0.05). For CAO, DECAF and BAP-65 demonstrated the most balanced performance at optimal cutoff, with sensitivities of 69.8% (95% CI: 61.9–75.4) and 68.2% (95% CI: 59.7–75.6) and specificities of 78.7% (95% CI: 0.74.5–0.81.8) and 78% (95% CI: 72.5–82.5). OCRS had a sensitivity of 61.2% (95% CI: 52.6–0.77) and a specificity of 84.8% (95% CI: 80.3–89.5). No significant confounding or effect modifications from demographics, lifestyle factors, or comorbidities were found except for age with DECAF, which performed better in younger patients. Conclusion: DECAF and BAP-65 showed the most balanced performances in predicting CAO amongst the three tools. Paired with a clinician’s judgment, these tools offer valuable insights for better triage and clinical decision-making in managing acute COPD exacerbation. © 2024 The Author(s).