<sec><title>BACKGROUND</title>This study aimed to investigate the overall prognostic performance of the DECAF (dyspnoea, eosinopenia, consolidation, acidaemia, atrial fibrillation) score for in-hospital death in patients with acute exacerbation of chronic obstructive pulmonary disease (AECOPD) through a retrospective cohort study and an updated meta-analysis.</sec><sec><title>METHODS</title>Sensitivity, specificity, and predictive performance of DECAF were analysed, using receiver operating characteristic (ROC) curves and area under the curve (AUC) as criteria for accuracy. A literature search was performed in databases. The summary ROC (SROC) curve was used to assess the overall performance of the DECAF score.</sec><sec><title>RESULTS</title>Twenty-three non-survivors and 292 survivors of AECOPD were included. At a cut-off value of 1.5, DECAF scores showed good sensitivity (78.3%), low specificity (55.1%), and AUC (0.719, 95% CI 0.614-0.824). Additionally, 22 studies (including our study) with 824 non-survivors and 8,957 survivors were included in this meta-analysis. The summary estimates were listed as follows: sensitivity 0.77 (95% CI 0.69-0.83); specificity 0.76 (95% CI 0.67-0.85); positive likelihood ratio 3.2 (95% CI 2.4-4.3); negative likelihood ratio 0.31 (95% CI 0.23-0.40); and diagnostic odds ratio 10.00 (95% CI 7-16). The AUC was 0.83 (95% CI 0.79-0.86).</sec><sec><title>CONCLUSIONS</title>The DECAF score is a simple tool to predict mortality in hospitalised patients with AECOPD, and the results of this study should be further validated.</sec>.