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McDonnell MJ, Aliberti S, Goeminne PC, Dimakou K, Zucchetti SC, Davidson J, Ward C, Laffey JG, Finch S, Pesci A, Dupont LJ, Fardon TC, Skrbic D, Obradovic D, Cowman S, Loebinger MR, Rutherford RM, De Soyza A, Chalmers JD. Multidimensional severity assessment in bronchiectasis: an analysis of seven European cohorts. Thorax 2016; 71:1110-1118. [PMID: 27516225 PMCID: PMC5136700 DOI: 10.1136/thoraxjnl-2016-208481] [Citation(s) in RCA: 105] [Impact Index Per Article: 13.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/12/2016] [Revised: 06/19/2016] [Accepted: 06/26/2016] [Indexed: 12/21/2022]
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.
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Affiliation(s)
- M J McDonnell
- Department of Respiratory Medicine, Galway University Hospitals, Galway, Ireland.,Institute of Cellular Medicine and Adult Bronchiectasis Service, Freeman Hospital, Newcastle University, Newcastle-upon-Tyne, UK.,Lung Biology Group, National University of Ireland, Galway, Ireland
| | - S Aliberti
- Department of Pathophysiology and Transplantation, University of Milan, Milan, Italy.,Cardio-thoracic Unit and Cystic Fibrosis Adult Center, Fondazione IRCCS Cà Granda Ospedale Maggiore Policlinico, Milan, Italy
| | - P C Goeminne
- Department of Respiratory Medicine, University Hospital Gasthuisberg, Leuven, Belgium.,Department of Respiratory Medicine, AZ Nikolaas, Sint-Niklaas, Belgium
| | - K Dimakou
- Fifth Department of Pulmonary Medicine, "Sotiria" Chest Diseases Hospital, Athens, Greece
| | - S C Zucchetti
- Department of Pathophysiology and Transplantation, University of Milan, Milan, Italy.,Cardio-thoracic Unit and Cystic Fibrosis Adult Center, Fondazione IRCCS Cà Granda Ospedale Maggiore Policlinico, Milan, Italy
| | - J Davidson
- Institute of Cellular Medicine and Adult Bronchiectasis Service, Freeman Hospital, Newcastle University, Newcastle-upon-Tyne, UK
| | - C Ward
- Institute of Cellular Medicine and Adult Bronchiectasis Service, Freeman Hospital, Newcastle University, Newcastle-upon-Tyne, UK
| | - J G Laffey
- Lung Biology Group, National University of Ireland, Galway, Ireland.,Department of Anesthesia, Keenan Research Centre for Biomedical Science, St Michael's Hospital, University of Toronto, Toronto, Ontario, Canada
| | - S Finch
- Scottish Centre for Respiratory Research, University of Dundee, Ninewells Hospital and Medical School, Dundee, UK
| | - A Pesci
- Department of Health Science, University of Milan Bicocca, Clinica Pneumologica, AO San Gerardo, Monza, Italy
| | - L J Dupont
- Department of Respiratory Medicine, University Hospital Gasthuisberg, Leuven, Belgium
| | - T C Fardon
- Scottish Centre for Respiratory Research, University of Dundee, Ninewells Hospital and Medical School, Dundee, UK
| | - D Skrbic
- Institute for Pulmonary Diseases of Vojvodina Sremska Kamenica, Put doktora Goldmana 4, Sremska Kamenica, Serbia
| | - D Obradovic
- Institute for Pulmonary Diseases of Vojvodina Sremska Kamenica, Put doktora Goldmana 4, Sremska Kamenica, Serbia
| | - S Cowman
- Host Defence Unit, Royal Brompton Hospital and UK Imperial College, London, UK
| | - M R Loebinger
- Host Defence Unit, Royal Brompton Hospital and UK Imperial College, London, UK
| | - R M Rutherford
- Department of Respiratory Medicine, Galway University Hospitals, Galway, Ireland
| | - A De Soyza
- Institute of Cellular Medicine and Adult Bronchiectasis Service, Freeman Hospital, Newcastle University, Newcastle-upon-Tyne, UK
| | - J D Chalmers
- Scottish Centre for Respiratory Research, University of Dundee, Ninewells Hospital and Medical School, Dundee, UK
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