BAP 65 and DECAF scores in Predicting Outcomes in Acute Exacerbation of Chronic Obstructive Pulmonary Disease: A Prospective Observational Study
Introduction: Chronic Obstructive Pulmonary Disease (COPD) is the fourth most common cause of mortality in the world. Acute Exacerbation of COPD (AECOPD) is a common entity to the emergency room of physician. It also contributes to the morbidity and mortality of the disease. Since multiple facto...
| Main Authors: | , , |
|---|---|
| Format: | Article |
| Language: | English |
| Published: |
JCDR Research and Publications Private Limited
2020-11-01
|
| Series: | Journal of Clinical and Diagnostic Research |
| Subjects: | |
| Online Access: | https://jcdr.net/articles/PDF/14176/46312_CE[Ra1]_F(SL)_PF1(AG_KM)_PFA(KM)_PB(AG_KM)_PN(SL).pdf |
| Summary: | Introduction: Chronic Obstructive Pulmonary Disease (COPD)
is the fourth most common cause of mortality in the world.
Acute Exacerbation of COPD (AECOPD) is a common entity
to the emergency room of physician. It also contributes to the
morbidity and mortality of the disease. Since multiple factors
influence the outcomes of AECOPD, many prognostic indices
incorporating various parameters have been proposed. BAP
65 {Blood Urea Nitrogen (BUN), Altered mental status, Pulse
rate and age >65 years} and Dyspnoea grade, Eosinopenia,
Consolidation, Acidemia and Atrial fibrillation (DECAF) are two
which are commonly used. Head-to-head comparisons of these
scores in their ability to correctly predict outcomes will aid the
clinician in decision-making.
Aim: To evaluate the performance of BAP 65 and DECAF scores
in accurately predicting need for mechanical ventilation and
mortality in patients with AECOPD.
Materials and Methods: In this prospective observational
study, 170 patients presenting with AECOPD to the emergency
department were recruited consecutively. All patients were
clinically examined and all variables for the calculation of the
two scores were documented at baseline. Routine neurological
examination was used to determine altered sensorium at
admission. Following this, all patients underwent appropriate
investigations including chest X-ray, Electrocardiogram
(ECG) and arterial blood gas estimation. BAP 65 and DECAF
scores were recorded and patients were followed till death
or improvement. The results were analysed using Statistical
Package for the Social Sciences (SPSS) software version 23.
Student’s t-test, Mann-Whitney test and Chi-square test were
used depending on the type of variables. Receiver Operating
Characteristic (ROC) analysis was done and Area Under the
Curve (AUC) was determined. A p-value <0.5 was deemed to
be significant for all tests.
Results: Out of 170 patients, 48 required non-invasive
ventilation and 30 required invasive ventilation and 23 (13.5%)
expired. Mortality correlated significantly with age, median
years of COPD, smoking pack years and hospitalisations in the
past one year and also with lower haemoglobin and higher total
leucocyte counts and BUN values. Both BAP 65 and DECAF
scores correlated with need for mechanical ventilation and
mortality. Area Under Receiver Operator Characteristic Curves
(AUROC) predicting mortality was 0.712 for BAP 65 and 0.965
for DECAF scores. AUROC predicting need for ventilation was
0.583 for BAP 65 and 0.791 for DECAF scores. DECAF showed
sensitivity of 78.26%, specificity of 95.92%, Positive Predictive
Value (PPV) of 75%, Negative Predictive Value (NPV) of 96.58%,
with an accuracy of 87.09% in predicting mortality. In predicting
need for mechanical ventilation, DECAF had sensitivity of
32.14%, specificity of 94.74%, PPV of 75%, NPV of 73.97%
with an accuracy of 63.44%. DECAF showed a higher positive
predictive value for both outcomes.
Conclusion: History and basic clinical examination provide a
lot of data to formulate prognosis in AECOPD. In resource-poor
settings, BAP 65 can be used while DECAF can be used where
arterial blood gas analysis is readily available, since both have
proven to correlate with outcomes. |
|---|---|
| ISSN: | 2249-782X 0973-709X |