Multidimensional severity assessment in bronchiectasis: an analysis of seven European cohorts

M J McDonnell, S Aliberti, P C Goeminne, K Dimakou, S C Zucchetti, J Davidson, C Ward, J G Laffey, S Finch, A Pesci, L J Dupont, T C Fardon, D Skrbic, D Obradovic, S Cowman, M R Loebinger, R M Rutherford, A De Soyza, J D Chalmers, M J McDonnell, S Aliberti, P C Goeminne, K Dimakou, S C Zucchetti, J Davidson, C Ward, J G Laffey, S Finch, A Pesci, L J Dupont, T C Fardon, D Skrbic, D Obradovic, S Cowman, M R Loebinger, R M Rutherford, A De Soyza, J D Chalmers

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.

Keywords: Bronchiectasis; Respiratory Infection.

Conflict of interest statement

Competing interests: None declared.

Published by the BMJ Publishing Group Limited. For permission to use (where not already granted under a licence) please go to http://www.bmj.com/company/products-services/rights-and-licensing/.

Figures

Figure 1
Figure 1
Bar graphs showing quality of life, symptoms and lung function decline. For SGRQ and FEV1 decline, bars show mean with SEM. For Leicester Cough Questionnaire and 6 min walking distance, mean, SD and range are shown. BSI, Bronchiectasis Severity Index, SGRQ, St Georges Respiratory Questionnaire.

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