https://doi.org/10.4081/ecj.2026.15652
Comparison of CURB-65, BAP65, and DECAF scores for risk stratification in acute exacerbation of COPD
All claims expressed in this article are solely those of the authors and do not necessarily represent those of their affiliated organizations, or those of the publisher, the editors and the reviewers. Any product that may be evaluated in this article or claim that may be made by its manufacturer is not guaranteed or endorsed by the publisher.
Accepted: 21 August 2026
Published: 5 October 2026
According to the WHO, Chronic obstructive pulmonary disease is the fourth leading cause of death worldwide. Acute exacerbations of COPD (AECOPD) are critical events that affect quality of life, increase hospital admissions, and mortality rates. DECAF, BAP-65, and CURB-65 scores are commonly used for risk stratification. However, limited comparative data exist regarding their prognostic performance in Indian populations presenting to the emergency departments. The primary outcome of the study is to compare the DECAF, BAP-65, and CURB-65 scoring systems for predicting in-hospital mortality. The secondary outcome is to assess the need for mechanical ventilation. This prospective, cross-sectional, observational study was conducted at a tertiary care teaching hospital. Adult patients who presented to the Emergency Department (ED) with Acute Exacerbations of COPD were enrolled from April 2023 to December 2025. Demographic details, DECAF, BAP-65, and CURB-65 scores were recorded after initial assessment. ROC and Area Under Curve analysis were done to assess the prognostic performance of the individual score. Of the total 100 participants, 59% were females. The areas under the curve for DECAF, CURB-65, and BAP-65 are 0.806, 0.707, and 0.673, respectively. A DECAF score of more than 04 was associated with the need for mechanical ventilation. The DECAF score was found to be a better risk stratification tool to predict mortality (score >4) and need for mechanical ventilation (score >3) in acute exacerbations of chronic obstructive pulmonary disease.
Downloads
1. WHO. Chronic obstructive pulmonary disease (COPD). Accessed 2026 Apr 16. Available from: https://www.who.int/news-room/fact-sheets/detail/chronic-obstructive-pulmonary-disease-(copd)
2. Allena N, Khanal S, Jog A, et al. Decoding the Chronic Obstructive Pulmonary Disease (COPD) puzzle: investigating the significance of exacerbation scores in triage decision-making. Cureus 2023;15:e41975. DOI: https://doi.org/10.7759/cureus.41975
3. Su H, Li F, Li J. The analysis of risk factors associated with readmission in patients with exacerbation of COPD. Medicine (Baltimore) 2025;104:e41997. DOI: https://doi.org/10.1097/MD.0000000000041997
4. Qian Y, Sun C, Zhang L, et al. Risk factors for acute exacerbation in patients with COPD group E in Ningbo: Risk analysis of irregular review, cardiovascular complications, and lung function decline. Int J Chron Obstruct Pulmon Dis 2025;20:2787–99. DOI: https://doi.org/10.2147/COPD.S510906
5. Shaista G, Idrees N, Panjwani K, et al. CURB-65 scoring utilization in predicting mortality of hospitalized patients with AE-COPD. Eur Respir J 2014;40:738.
6. Germini F, Veronese G, Marcucci M, et al. Validation of the BAP-65 score for prediction of in-hospital death or use of mechanical ventilation in patients presenting to the emergency department with an acute exacerbation of COPD: a retrospective multi-center study from the Italian Society of Emergency Medicine (SIMEU). Eur J Intern Med 2019;61:62–8. DOI: https://doi.org/10.1016/j.ejim.2018.10.018
7. Rakshana S, Velraj R. DECAF score and BAP-65 score as tools for prediction of clinical outcome in acute exacerbation of chronic obstructive pulmonary disease. J Educ Soc Res 2024;14:1182-1191.
8. Candemir Ergene G, Doğan NÖ, Ergül T, et al. Evaluating the prognostic value of DECAF score and procalcitonin in patients with COPD exacerbation. Am J Emerg Med 2025;90:23–30. DOI: https://doi.org/10.1016/j.ajem.2025.01.012
9. Verma A, Gudi N, Yadav UN, et al. Prevalence of COPD among population above 30 years in India: A systematic review and meta-analysis. J Glob Health 2021;11:04038. DOI: https://doi.org/10.7189/jogh.11.04038
10. 2025 GOLD Report. Global initiative for chronic obstructive lung disease - GOLD. Accessed 2026 May 9. Available from: https://goldcopd.org/2025-gold-report/
11. Ji Z, Li X, Lei S, et al. A pooled analysis of the risk prediction models for mortality in acute exacerbation of chronic obstructive pulmonary disease. Clin Respir J 2023;17:707. DOI: https://doi.org/10.1111/crj.13606
12. Owusuaa C, Dijkland SA, Nieboer D, et al. Predictors of mortality in chronic obstructive pulmonary disease: a systematic review and meta-analysis. BMC Pulm Med 2022;22:125. DOI: https://doi.org/10.1186/s12890-022-01911-5
13. Shiroshita A, Kimura Y, Shiba H, et al. Predicting in-hospital death in pneumonic COPD exacerbation via BAP-65, CURB-65 and machine learning. ERJ Open Res 2022;8:452. DOI: https://doi.org/10.21203/rs.3.rs-687032/v1
14. Skajaa N, Laugesen K, Horváth-Puhó E, Sørensen HT. Comorbidities and mortality among patients with chronic obstructive pulmonary disease. BMJ Open Respir Res 2023;10:e001798. DOI: https://doi.org/10.1136/bmjresp-2023-001798
15. Meena SB, Bhat P, Magh H, Akhil A. DECAF score and BAP-65, the tools for prognosis in acute exacerbation of chronic obstructive pulmonary disease: a prospective observational study. J Clin Diagn Res 2023;17:OC27-32. DOI: https://doi.org/10.7860/JCDR/2023/62518.18188
16. Shen MH, Qiu GQ, Wu XM, Dong MJ. Utility of the DECAF score for predicting survival of patients with COPD: a meta-analysis of diagnostic accuracy studies. Eur Rev Med Pharmacol Sci 2021;25:4037-50.
17. Belagavi VV, Kumhar M, Tak H, et al. Comparison of scoring systems in acute exacerbation of COPD. Eur J Cardiovasc Med 2025;15:579–86.
18. Memon MA, Faryal S, Brohi N, Kumar B. Role of the DECAF score in predicting in-hospital mortality in acute exacerbation of chronic obstructive pulmonary disease. Cureus 2019;11:e4826. DOI: https://doi.org/10.7759/cureus.4826
19. Sharma S, Khan K, Yadav GS, Koolwal S. A study of modified decaf score in predicting hospital outcomes in patients of acute exacerbation of chronic obstructive pulmonary disease at SMS Medical College, Jaipur. Adv Hum Biol 2020;10:171. DOI: https://doi.org/10.4103/AIHB.AIHB_35_20
20. Cojocaru E, Haliga RE, Ene GB, Cojocaru C. Mortality predictors in patients with severe COPD exacerbation. J Clin Med 2025;14:3028. DOI: https://doi.org/10.3390/jcm14093028
Ethics Approval
CRediT authorship contribution
Shabbir Shekhli, conceptualization, formal analysis, validation, methodology (lead); ,1 Basava Kirana, software, writing – review & editing, data curation.
Supporting Agencies
Data Availability Statement
Data will be accessible upon request to the corresponding author six months post-publication. The sensitive information of study participants will be anonymized.
How to Cite
This work is licensed under a Creative Commons Attribution-NonCommercial 4.0 International License.
PAGEPress has chosen to apply the Creative Commons Attribution NonCommercial 4.0 International License (CC BY-NC 4.0) to all manuscripts to be published.
