Introduction Bronchiectasis is a chronic, disabling illness with an unpredictable clinical course. Two multidimensional scores have been developed to predict mortality in bronchiectasis: the bronchiectasis severity index (BSI) and the FACED score.1,2 This study is a retrospective cohort study aiming to compare these scores and test their ability to predict long-term mortality in bronchiectasis.
Methods Data was obtained for 74 subjects with bronchiectasis who had previously taken part in research at our centre. BSI and FACED scores were calculated and outcomes were ascertained after a median of 18.8 years follow-up. Receiver operator characteristic (ROC) curves for mortality were generated and survival between groups compared using univariate Cox proportional hazards analysis.
Results Both scoring systems had similarly excellent predictive power for 5-year mortality, with area under the ROC curve (AUC) 0.79 for BSI and 0.8 for FACED. Both scores were also able to predict 15-year mortality (Figure 1), with the FACED score showing superior predictive power (AUC 0.82 vs 0.69 P = 0.0495). For both scores subjects with high scores had an increased risk of death compared to the low scoring group (hazard ratio (HR) for death 3.6 for BSI P = 0.02, 12.5 for FACED P < 0.001). The intermediate scoring FACED group was also at an increased risk of death (HR 5.9 P < 0.001), whereas the intermediate BSI group was not (HR 1.4 P = 0.58). The BSI tended to assign higher scores; accordingly the high BSI group was larger (33 vs 6 subjects) with a lower mortality (57% vs 83%) than the equivalent FACED group.
Conclusion This study demonstrates the ability of the BSI and FACED score to predict mortality in bronchiectasis over a far longer period than previously described. Such tools will be valuable for stratification in clinical trials and for identifying individuals in a higher risk group for intensified treatment.
References 1 Chalmers JD, Goeminne P, Aliberti S, et al. The bronchiectasis severity index. An international derivation and validation study. Am J Respir Crit Care Med. 2014;189:576–85
2 Martínez-García MÁ, de Gracia J, Vendrell Relat M, et al. Multidimensional approach to non-cystic fibrosis bronchiectasis. The FACED score. Eur Respir J. 2014;43:1357–1367
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