OCRS, DECAF, and BAP-65 scores for predicting the outcomes of acute COPD exacerbation: A prognostic accuracy study
نویسندگان
1 Research Center for Trauma in Police Operations, Directorate of Health, Rescue & Treatment, Police Headquarter, Tehran, Iran
2 Men‘s Health and Reproductive Health Research Center, Shahid Beheshti University of Medical Science, Tehran, Iran
3 Research Center for Trauma in Police Operations, Directorate of Health, Rescue & Treatment, Police Headquarter, Tehran, Iran
4 Emergency Care Promotion Research Center, Shahid Beheshti University of Medical Science, Tehran, Iran
doi
10.34172/jept.2025.16چکیده
Objective: Acute exacerbation of chronic obstructive pulmonary disease (COPD) is a significanthealthcare burden. This study aimed to compare three risk assessment tools in predicting theoutcomes of COPD exacerbation.Methods: This prospective cohort study was conducted between October 2023 and November2024 at five hospitals in Iran (three in Tehran, one in Shahr-e-Rey, and one in Nehbandan). A total of392 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 adverseoutcomes (ICU admission, mechanical ventilation, and mortality) was assessed. The area under thereceiver operating characteristic curve (AUC-ROC) and performance metrics (sensitivity, specificity,predictive values, and likelihood ratios) were calculated for each score. AUCs were compared usingpaired 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 optimalcutoff, with sensitivities of 69.8% (95% CI: 61.9–75.4) and 68.2% (95% CI: 59.7–75.6) and specificitiesof 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 effectmodifications from demographics, lifestyle factors, or comorbidities were found except for age withDECAF, which performed better in younger patients.Conclusion: DECAF and BAP-65 showed the most balanced performances in predicting CAOamongst the three tools. Paired with a clinician’s judgment, these tools offer valuable insights forbetter triage and clinical decision-making in managing acute COPD exacerbation.
