Validation and Comparison of BAP-65, DECAF, NEWS, and a Novel Combined Score for Predicting in-Hospital Mortality in Patients with Acute Exacerbation of COPD.

Purpose: Acute exacerbations of chronic obstructive pulmonary disease (AECOPD) are a major cause of hospital admissions and are associated with significant morbidity and mortality. Several scoring systems are available for early risk stratification, such as DECAF, BAP-65, and NEWS, each incorporating parameters from different clinical domains. This study aimed to validate and compare established risk scores for predicting in-hospital mortality in patients with AECOPD and to assess the accuracy of a novel composite model. Patients and Methods: The BAP-65 score, a modified version of the DECAF score (DECAFm), and the National Early Warning Score (NEWS) were calculated using admission data of patients hospitalized for AECOPD in a Swiss hospital in 2022 and 2023. Predictive power for in-hospital death was compared using receiver operating characteristic (ROC) curves and the respective area under the curve (AUC). A novel scoring system, AECOPD-COMBI, combining parameters used in the three scores, was validated in the same cohort. Results: 314 patients (mean age 73 years (range 48-94), 47% female) were included, of whom 7 died during hospitalization (2.2%). Patients who died had significantly higher scores at admission across all validated tools. Among the established scores, the BAP-65 performed best in the prediction of in-hospital death (AUC 0.79), followed by DECAFm (AUC 0.72) and NEWS (0.64). The novel AECOPD-COMBI reached the highest AUC of 0.9 and, when setting the high-risk score threshold to Conclusion: The AECOPD-COMBI score showed promising potential in identifying patients at risk of in-hospital death, potentially outperforming established scores. While the cohort's low event rate may have influenced predictive estimates and performance differences were not statistically significant, these findings still highlight the score's potential value in clinical decision-making. Given the small sample size and preliminary nature of the study, these results should be interpreted with caution. Larger studies are needed to validate the score's applicapbility and assess its performance for other relevant outcomes.