Comparative Analysis of the COPD Assessment Test and Modified DECAF Score in Predicting Clinical Outcomes Among Patients With Acute Exacerbation of COPD: A Prospective Observational Study.

Background Acute exacerbation of chronic obstructive pulmonary disease (AECOPD) significantly impacts patient outcomes and healthcare resources. While various assessment tools exist, the comparative effectiveness of the COPD Assessment Test (CAT) and Dyspnea, Eosinopenia, Consolidation, Acidemia, and Atrial Fibrillation (DECAF) score in predicting clinical outcomes remains unclear. This study aims to determine whether the modified DECAF score provides superior prognostic accuracy compared to the CAT in predicting clinical outcomes of patients with AECOPD. Methodology A prospective observational study was conducted at the Department of Respiratory Medicine, Sri Ramachandra Institute of Higher Education and Research, from January 2023 to April 2024. The study enrolled 120 participants aged 40-80 years with physician-diagnosed COPD, using consecutive sampling. Patients with stable, well-controlled comorbidities and no exacerbations within 90 days were included. Data collection involved demographic information, clinical parameters, and laboratory investigations using standardized protocols. The CAT score assessed symptom burden across eight parameters, while the modified DECAF score evaluated dyspnea, eosinopenia, consolidation, acidemia, and atrial fibrillation. Statistical analysis employed Fisher's exact test and ANOVA, with p<0.05 considered significant. Results The study population comprised 104 (86.7%) male patients and 16 (13.3%) female patients, with 45 (37.5%) participants aged 61-70 years. The modified DECAF score demonstrated superior prognostic capability compared to CAT scores. In CAT score stratification, among patients with scores <10, 35 (79.54%) achieved cure while nine (20.45%) died; in the 10-20 category, 40 (86.95%) were cured and six (13.04%) died; and for scores >20, 23 (76.66%) recovered while seven (23.33%) died, showing no significant association (p = 0.474). In contrast, the modified DECAF system showed that all 70 (100%) low-risk and 21 (100%) intermediate-risk patients survived, while in the high-risk category, seven (24.13%) were cured and 22 (75.86%) died (p = 0.001). Ventilatory support requirements significantly increased with higher modified DECAF risk categories, with 26 (89.65%) high-risk patients requiring invasive mechanical ventilation (p = 0.001). The mean hospital stay duration varied significantly across modified DECAF categories: low-risk 7.27 days, intermediate-risk 8.33 days, and high-risk 17.43 days (p = 0.001). Conclusion The modified DECAF score demonstrates superior prognostic capability compared to CAT in predicting AECOPD outcomes, showing significant associations with mortality, ventilatory support requirements, and hospital stay duration. These findings support incorporating modified DECAF scoring into routine clinical practice for improved risk stratification and targeted interventions in AECOPD management.