Evaluating the Prognostic Value of DECAF Score and Procalcitonin in COPD Exacerbations

Evaluating the Prognostic Value of DECAF Score and Procalcitonin in COPD Exacerbations

Authors: Gülcan Candemir Ergene, Nurettin Özgür Doğan, Tuğçe Ergül, İbrahim Ulaş Özturan, Murat Pekdemir, Elif Yaka, Serkan Yilmaz
Journal: American Journal of Emergency Medicine, 2025

Conclusions:

  • Both DECAF score and procalcitonin demonstrated robust and similar prognostic accuracy in predicting adverse outcomes in AECOPD patients.

  • Combining DECAF with procalcitonin enhanced predictive reliability, achieving a 100% NPV for excluding adverse outcomes.

  • Incorporating both tools into clinical practice may optimize risk stratification and management in AECOPD patients.

Methods:

  • Study Design: Retrospective cohort study over three years.

  • Population: AECOPD patients with serum procalcitonin levels measured at ED presentation.

  • Primary Outcome: One-month mortality.

  • Secondary Outcomes: ED re-admissions, hospitalization, and ICU admission.

  • Analysis: Prognostic performance assessed via receiver operating characteristic (ROC) curves and area under the curve (AUC). Negative predictive value (NPV) was calculated for individual and combined metrics.

Results:

Patient Demographics:

  • Total: 130 patients

    • Survivors: 105

    • Non-survivors: 25

Key Findings:

  1. DECAF Score:

    • Higher in non-survivors (4 [IQR: 3-4]) vs. survivors (3 [IQR: 2-4]), (p < 0.001).

    • AUC = 0.758 (95% CI: 0.673-0.842).

  2. Procalcitonin Levels:

    • Elevated in non-survivors (0.26 ng/mL [IQR: 0.11-2.77]) vs. survivors (0.08 ng/mL [IQR: 0.04-0.21]), (p < 0.001).

    • AUC = 0.764 (95% CI: 0.668-0.860).

  3. Comparison of Predictive Accuracy:

    • No significant difference in AUC between DECAF and procalcitonin (p = 0.927).

  4. Negative Predictive Value (NPV):

    • DECAF score (≥4): 90.6%.

    • Procalcitonin (cut-off 0.075 ng/mL): 96.2%.

    • Combined DECAF and PCT: 100% NPV (95% CI: 89.1%-100%).


Ergene, G.C., Doğan, N.Ö., Ergül, T., Özturan, İ.U., Pekdemir, M., Yaka, E. and Yilmaz, S., 2025. Evaluating the prognostic value of decaf score and procalcitonin in patients with COPD exacerbation. The American Journal of Emergency Medicine.

Back to blog