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.
- Respiratory Infection
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ADS and JDC have joint senior authorship.
Contributors All authors participated in study design, data analysis and interpretation of the data. All authors were involved in writing and revising the article before submission.
Funding This study was funded by the European Respiratory Society through a Clinical Research Collaboration grant to EMBARC, the European Bronchiectasis Registry (https://www.bronchiectasis.eu/). The authors acknowledge funding from Bayer HealthCare in the set-up and development of the EMBARC. MJMcD acknowledges fellowship support from the European Respiratory Society/European Lung Foundation and Health Research Board, Ireland. JDC acknowledges fellowship support from the Wellcome Trust.
Competing interests None declared.
Ethics approval Ethical approval was granted from each individual centre's Research Ethics Committee.
Provenance and peer review Not commissioned; externally peer reviewed.