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Original article
Multidimensional severity assessment in bronchiectasis: an analysis of seven European cohorts
  1. M J McDonnell1,2,3,
  2. S Aliberti4,5,
  3. P C Goeminne6,7,
  4. K Dimakou8,
  5. S C Zucchetti4,5,
  6. J Davidson2,
  7. C Ward2,
  8. J G Laffey3,9,
  9. S Finch10,
  10. A Pesci11,
  11. L J Dupont6,
  12. T C Fardon10,
  13. D Skrbic12,
  14. D Obradovic12,
  15. S Cowman13,
  16. M R Loebinger13,
  17. R M Rutherford1,
  18. A De Soyza2,
  19. J D Chalmers10
  1. 1Department of Respiratory Medicine, Galway University Hospitals, Galway, Ireland
  2. 2Institute of Cellular Medicine and Adult Bronchiectasis Service, Freeman Hospital, Newcastle University, Newcastle-upon-Tyne, UK
  3. 3Lung Biology Group, National University of Ireland, Galway, Ireland
  4. 4Department of Pathophysiology and Transplantation, University of Milan, Milan, Italy
  5. 5Cardio-thoracic Unit and Cystic Fibrosis Adult Center, Fondazione IRCCS Cà Granda Ospedale Maggiore Policlinico, Milan, Italy
  6. 6Department of Respiratory Medicine, University Hospital Gasthuisberg, Leuven, Belgium
  7. 7Department of Respiratory Medicine, AZ Nikolaas, Sint-Niklaas, Belgium
  8. 8Fifth Department of Pulmonary Medicine, “Sotiria” Chest Diseases Hospital, Athens, Greece
  9. 9Department of Anesthesia, Keenan Research Centre for Biomedical Science, St Michael's Hospital, University of Toronto, Toronto, Ontario, Canada
  10. 10Scottish Centre for Respiratory Research, University of Dundee, Ninewells Hospital and Medical School, Dundee, UK
  11. 11Department of Health Science, University of Milan Bicocca, Clinica Pneumologica, AO San Gerardo, Monza, Italy
  12. 12Institute for Pulmonary Diseases of Vojvodina Sremska Kamenica, Put doktora Goldmana 4, Sremska Kamenica, Serbia
  13. 13Host Defence Unit, Royal Brompton Hospital and UK Imperial College, London, UK
  1. Correspondence to Dr M J McDonnell, Institute of Cellular Medicine and Adult Bronchiectasis Service, Freeman Hospital, Newcastle University, Newcastle-upon-Tyne NE4 4HH, UK; melissajanefriel{at}gmail.com

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.

  • Bronchiectasis
  • Respiratory Infection

This is an Open Access article distributed in accordance with the terms of the Creative Commons Attribution (CC BY 4.0) license, which permits others to distribute, remix, adapt and build upon this work, for commercial use, provided the original work is properly cited. See: http://creativecommons.org/licenses/by/4.0/

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Footnotes

  • 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.

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