The Role of the A-DECAF Score in Predicting Long-Term Survival in COPD-Related Hypercapnic Respiratory Failure

Background and Objectives: Data on the prognosis of hypercapnic respiratory failure (HRF) are limited, despite existing studies focusing on its causes and association with mortality. This study aimed to evaluate prognostic factors influencing long-term survival in patients with HRF due to chronic obstructive pulmonary disease (COPD) and to assess the effectiveness of the Age-adjusted Dyspnea, Eosinopenia, Consolidation, Acidemia and Atrial Fibrillation (A-DECAF) score. Materials and Methods: This retrospective study included patients admitted to the intensive care unit from the emergency department with HRF between April 2022-November 2023. Demographic data, comorbidities, laboratory results, and treatment protocols were recorded. A-DECAF scores were calculated, and survival was analyzed using Kaplan-Meier and ROC analysis. Results: Among 357 patients, 24.4% died within one year of discharge. Deceased patients had significantly higher mean ages (p<0.001) and higher APACHE-II, DECAF and A-DECAF scores (p<0.001). ROC analysis showed that A-DECAF had the highest sensitivity (93.1%) and accuracy (AUC=0.813) for predicting survival. Kaplan-Meier analysis indicated that higher A-DECAF scores were associated with reduced survival rates. Conclusion: The A-DECAF score is an effective tool for predicting long-term survival in COPD patients with HRF, particularly aiding clinical decisions in elderly populations. Further research is needed to validate its use in diverse patient groups.