Clinical Utility of the DECAF Score in Predicting In-Hospital Mortality and Adverse Outcomes in Acute Exacerbations of Chronic Obstructive Pulmonary Disease: A Narrative Review

Abstract

Acute exacerbations of chronic obstructive pulmonary disease (AECOPD) are a leading cause of hospital admissions and are associated with substantial in-hospital mortality. Early risk stratification is essential to guide clinical decision-making, optimize resource utilization, and improve outcomes. Several prognostic tools have been evaluated in AECOPD; however, many lack disease specificity or practical bedside applicability. The Dyspnea, Eosinopenia, Consolidation, Acidemia, and Atrial Fibrillation (DECAF) score has emerged as a simple, COPD-specific prognostic model designed to predict in-hospital mortality. This narrative review synthesizes evidence from multiple observational studies, validation cohorts, and comparative analyses assessing the performance of the DECAF score in hospitalized AECOPD patients. Available data consistently demonstrate that the DECAF score provides good discriminatory ability for mortality prediction and often outperforms commonly used generic severity scores. Its ease of use and reliance on routinely available clinical parameters make it a valuable tool for early risk assessment and clinical triage in AECOPD.