Multidimensional severity assessment in bronchiectasis: an analysis of seven European cohorts
File(s)
Published version
Author(s)
Type
Journal Article
Abstract
INTRODUCTION: Bronchiectasis is a multidimensional disease associated with substantial morbidity and mortality. Two disease-specific clinical prediction tools have been developed, the Bronchiectasis Severity Index (BSI) and the FACED score, both of which stratify patients into severity risk categories to predict the probability of mortality. METHODS: We aimed to compare the predictive utility of BSI and FACED in assessing clinically relevant disease outcomes across seven European cohorts independent of their original validation studies. RESULTS: The combined cohorts totalled 1612. Pooled analysis showed that both scores had a good discriminatory predictive value for mortality (pooled area under the curve (AUC) 0.76, 95% CI 0.74 to 0.78 for both scores) with the BSI demonstrating a higher sensitivity (65% vs 28%) but lower specificity (70% vs 93%) compared with the FACED score. Calibration analysis suggested that the BSI performed consistently well across all cohorts, while FACED consistently overestimated mortality in 'severe' patients (pooled OR 0.33 (0.23 to 0.48), p<0.0001). The BSI accurately predicted hospitalisations (pooled AUC 0.82, 95% CI 0.78 to 0.84), exacerbations, quality of life (QoL) and respiratory symptoms across all risk categories. FACED had poor discrimination for hospital admissions (pooled AUC 0.65, 95% CI 0.63 to 0.67) with low sensitivity at 16% and did not consistently predict future risk of exacerbations, QoL or respiratory symptoms. No association was observed with FACED and 6 min walk distance (6MWD) or lung function decline. CONCLUSION: The BSI accurately predicts mortality, hospital admissions, exacerbations, QoL, respiratory symptoms, 6MWD and lung function decline in bronchiectasis, providing a clinically relevant evaluation of disease severity.
Date Issued
2016-08-11
Date Acceptance
2016-06-26
Citation
Thorax, 2016, 71, pp.1110-1118
ISSN
1468-3296
Publisher
BMJ Publishing Group
Start Page
1110
End Page
1118
Journal / Book Title
Thorax
Volume
71
Copyright Statement
© 2016 The Authors. Published by the BMJ Publishing Group Limited. This is an Open Access article distributed in accordance with the Creative Commons Attribution Non Commercial (CC BY-NC 4.0) license, which permits others to distribute, remix, adapt, build upon this work non-commercially, and license their derivative works on different terms, provided the original work is properly cited and the use is non-commercial. See: http://creativecommons.org/licenses/by-nc/4.0/
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Subjects
Science & Technology
Life Sciences & Biomedicine
Respiratory System
CYSTIC-FIBROSIS BRONCHIECTASIS
PREDICTING MORTALITY
OBSERVATIONAL COHORT
ADULT PATIENTS
LUNG-FUNCTION
FACED SCORE
DRY POWDER
QUESTIONNAIRE
VALIDATION
DISEASE
Bronchiectasis
Respiratory Infection
Aged
Disease Progression
Europe
Female
Follow-Up Studies
Forced Expiratory Volume
Hospitalization
Humans
Male
Middle Aged
Predictive Value of Tests
Prognosis
Quality of Life
Risk Assessment
Severity of Illness Index
1103 Clinical Sciences
Publication Status
Published