Comparison of HALP and DECAF in predicting 30 day in hospital mortality in a retrospective cohort study of acute exacerbation of COPD.
- 1Department of Emergency Medicine, Evliya Celebi Training and Research Hospital, Kutahya, Turkey. [email protected].
- 2Department of Emergency Medicine, Evliya Celebi Training and Research Hospital, Kutahya, Turkey.
- 3Department of Emergency Medicine, Kutahya Health Sciences University Medical School, Kutahya, Turkey.
Abstract
Background
Acute exacerbations of chronic obstructive pulmonary disease (AECOPD) are associated with substantial short term mortality and healthcare utilization, yet the prognostic utility of the immunonutrition based hemoglobin, albumin, lymphocyte, and platelet (HALP) score in this setting remains unclear, particularly in comparison with the well validated dyspnoea, eosinopenia, consolidation, acidaemia, atrial fibrillation (DECAF) score.Methods
We conducted a retrospective, single centre observational cohort study of adults presenting to the emergency department (ED) with AECOPD between June 2022 and June 2025. DECAF and HALP scores were calculated at admission using routinely collected clinical and laboratory data, and the primary outcome was 30 day in hospital mortality. Discrimination was assessed using receiver operating characteristic (ROC) analysis, with Youden-derived, data-driven cut-off values, and we further evaluated previously validated DECAF thresholds and a categorical DECAF model. Associations with 30 day mortality were examined using univariable and multivariable logistic regression models adjusted for baseline clinical variables. Model calibration was evaluated using Brier scores and the Hosmer-Lemeshow test, and 30 day survival was analysed with Kaplan-Meier.Results
A total of 499 patients were included in the study, 63 (12.6%) died within 30 days, and 76% of the cohort were male. The HALP score showed acceptable predictive performance (area under the curve (AUC) 0.724), at a cut-off of 16.84, sensitivity was 57.1%, specificity 75.0% and negative predictive value (NPV) 92.4% for 30 day in hospital mortality. The DECAF score demonstrated excellent discrimination for 30 day in hospital mortality (AUC 0.932), and showed significantly better discrimination than HALP (DeLong p < 0.001), using a cut-off of ≥ 4, sensitivity was 76.2%, specificity 95.6% and NPV 96.5%.Conclusion
In ED patients with AECOPD, the HALP score provides only limited prognostic information for 30 day in hospital mortality, whereas the DECAF score exhibits excellent discriminative performance and retains its value as a robust, clinically applicable predictor of short term outcomes in acute care.
Related
- Multi-model comparison and nomogram development for predicting in-hospital mortality in Trauma patients based on NLR and other indicators
- Systemic immune-inflammation index and in-hospital mortality in critically ill patients with acute asthma exacerbation: A retrospective cohort study.
- Head-to-head comparison of glucose-to-albumin ratio against five albumin-derived indices for predicting 28-day ICU mortality in critically ill patients with spontaneous intracerebral hemorrhage: a multicenter retrospective study.
- Association Between Neutrophil Percentage-to-Albumin Ratio and Prolonged Length of Hospital Stay in Older Patients with Acute Exacerbation of COPD: A Retrospective Analysis.
- Explainable machine learning and deep learning models for predicting in-hospital mortality in burn patients
BibTeX
@article{gode2026comparison,
title = {{Comparison of HALP and DECAF in predicting 30 day in hospital mortality in a retrospective cohort study of acute exacerbation of COPD.}},
author = {Ridvan Gode and Behcet Demir and Ertan Sonmez},
journal = {BMC pulmonary medicine},
year = {2026},
month = jul,
doi = {10.1186/s12890-026-04532-4},
url = {https://europepmc.org/article/MED/42897561},
note = {CC BY-NC-ND},
}
RIS
TY - JOUR
TI - Comparison of HALP and DECAF in predicting 30 day in hospital mortality in a retrospective cohort study of acute exacerbation of COPD.
AU - Ridvan Gode
AU - Behcet Demir
AU - Ertan Sonmez
PY - 2026
DA - 2026/07/01
JO - BMC pulmonary medicine
DO - 10.1186/s12890-026-04532-4
UR - https://europepmc.org/article/MED/42897561
AB - Background Acute exacerbations of chronic obstructive pulmonary disease (AECOPD) are associated with substantial short term mortality and healthcare utilization, yet the prognostic utility of the immunonutrition based hemoglobin, albumin, lymphocyte, and platelet (HALP) score in this setting remains unclear, particularly in comparison with the well validated dyspnoea, eosinopenia, consolidation, acidaemia, atrial fibrillation (DECAF) score.Methods We conducted a retrospective, single centre observational cohort study of adults presenting to the emergency department (ED) with AECOPD between June 2022 and June 2025. DECAF and HALP scores were calculated at admission using routinely collected clinical and laboratory data, and the primary outcome was 30 day in hospital mortality. Discrimination was assessed using receiver operating characteristic (ROC) analysis, with Youden-derived, data-driven cut-off values, and we further evaluated previously validated DECAF thresholds and a categorical DECAF model. Associations with 30 day mortality were examined using univariable and multivariable logistic regression models adjusted for baseline clinical variables. Model calibration was evaluated using Brier scores and the Hosmer-Lemeshow test, and 30 day survival was analysed with Kaplan-Meier.Results A total of 499 patients were included in the study, 63 (12.6%) died within 30 days, and 76% of the cohort were male. The HALP score showed acceptable predictive performance (area under the curve (AUC) 0.724), at a cut-off of 16.84, sensitivity was 57.1%, specificity 75.0% and negative predictive value (NPV) 92.4% for 30 day in hospital mortality. The DECAF score demonstrated excellent discrimination for 30 day in hospital mortality (AUC 0.932), and showed significantly better discrimination than HALP (DeLong p < 0.001), using a cut-off of ≥ 4, sensitivity was 76.2%, specificity 95.6% and NPV 96.5%.Conclusion In ED patients with AECOPD, the HALP score provides only limited prognostic information for 30 day in hospital mortality, whereas the DECAF score exhibits excellent discriminative performance and retains its value as a robust, clinically applicable predictor of short term outcomes in acute care.
SN - 1471-2466
ER -