Evaluation of the Modified DECAF Score in Risk Stratification of AECOPD Patients: A Comparative Analysis With the Original DECAF Score

Background Acute exacerbations of chronic obstructive pulmonary disease (AECOPD) significantly contribute to morbidity and mortality worldwide. The DECAF score is a widely used tool for predicting in-hospital mortality in AECOPD patients. A modified Dyspnea, Eosinopenia, Consolidation, Acidemia, and Atrial Fibrillation (DECAF) score incorporating exacerbation frequency has been proposed to enhance prognostic accuracy. This study aims to evaluate the correlation and agreement between the DECAF and modified DECAF scores in assessing severity among AECOPD patients. Methods This cross-sectional observational study was conducted at Sree Balaji Medical College and Hospital over one year (January-December 2024). Fifty-one (n = 51) patients admitted with AECOPD were retrospectively analyzed. DECAF and modified DECAF scores were calculated for each patient. Spearman's rank correlation was used to assess the relationship between the scores. Cohen's Kappa and McNemar's test were applied to evaluate agreement and classification shifts. Results A strong positive correlation was observed between the DECAF and modified DECAF scores (ρ = 0.702, p < 0.00001). Using the DECAF score, 47 patients (92.2%) were classified as low risk and four patients (7.8%) as high risk, while the modified DECAF reclassified four of the initial low-risk patients into the high-risk category based on exacerbation frequency. However, Cohen's Kappa showed no agreement beyond chance (κ = 0.00) in risk categorization, and McNemar's test indicated that this reclassification was not statistically significant (p = 0.125). The lack of agreement may indicate that the modified DECAF's emphasis on exacerbation frequency identifies different patient profiles, but it could also reflect limitations in its risk stratification ability or be due to the small sample size. Conclusion The modified DECAF score demonstrated strong correlation with the original DECAF score and identified additional high-risk patients based on exacerbation history. Recognizing these patients is clinically relevant, as higher modified DECAF scores have been associated with increased mortality, greater need for ventilatory support, and longer hospital stays, factors that can guide decisions about monitoring intensity and resource allocation. However, within our study cohort, no specific treatment or management decisions (such as escalation of care or intervention) were made solely on the basis of risk reclassification by the modified DECAF score. Thus, while the modified DECAF may improve clinician awareness of patients with more unstable disease profiles, further studies are warranted to determine whether its use should prompt tailored treatment strategies or changes in clinical pathways.