Comparative Evaluation of DECAF and BAP-65 Scores in Predicting Outcomes of COPD Exacerbations in In-patients at Vicente Sotto Memorial Medical Center
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Abstract
Objective: To compare the predictive performance of the Dyspnea–Eosinopenia–Consolidation–Acidemia–Atrial Fibrillation (DECAF) score and the Blood urea nitrogen–Altered mental status–Pulse–Age ≥65 years (BAP-65) score for in-hospital mortality and need for mechanical ventilation among Filipino patients hospitalized with AECOPD.
Methods: In this prospective cohort study, 80 adults admitted with AECOPD were consecutively enrolled. DECAF and BAP-65 scores were calculated within 24 hours of admission. Outcomes included in-hospital mortality and requirement for invasive or non-invasive mechanical ventilation. Diagnostic performance was assessed using sensitivity, specificity, positive predictive value (PPV), negative predictive value (NPV), and area under the receiver operating characteristic curve (AUROC).
Results: In-hospital mortality occurred in 39 patients (48.8%). For mortality prediction, DECAF demonstrated significantly higher sensitivity than BAP-65 (97.4% vs. 69.2%) but lower specificity (26.8% vs. 61.0%). For prediction of mechanical ventilation, DECAF showed superior sensitivity (95.7%) and specificity (90.0%) compared with BAP-65 (58.6% and 80.0%, respectively). The high sensitivity of DECAF translated into a high negative predictive value for mortality (91.7%), whereas BAP-65 provided better discrimination of low-risk survivors. These results suggest DECAF is more effective in identifying high-risk patients requiring intensive care, while BAP-65 may be useful for rapid bedside risk assessment where resources are limited.
Conclusion: Both DECAF and BAP-65 scores are clinically useful for risk stratification in hospitalized AECOPD. DECAF is highly sensitive for identifying patients at risk of death or respiratory failure, while BAP-65 offers better specificity and simplicity. Their complementary use may optimize clinical decision-making, particularly in resource-limited settings.
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Copyright (c) 2025 Pino AJ, et al.
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