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

被引:128
作者
McDonnell, M. J. [1 ,2 ,3 ,4 ]
Aliberti, S. [5 ,6 ,7 ]
Goeminne, P. C. [8 ,9 ]
Dimakou, K. [10 ]
Zucchetti, S. C. [5 ,6 ,7 ]
Davidson, J. [1 ,2 ]
Ward, C. [1 ,2 ]
Laffey, J. G. [4 ,11 ]
Finch, S. [12 ]
Pesci, A. [13 ]
Dupont, L. J. [8 ]
Fardon, T. C. [12 ]
Skrbic, D. [14 ]
Obradovic, D. [14 ]
Cowman, S. [15 ,16 ]
Loebinger, M. R. [15 ,16 ]
Rutherford, R. M. [3 ]
De Soyza, A. [1 ,2 ]
Chalmers, J. D. [12 ]
机构
[1] Newcastle Univ, Freeman Hosp, Inst Cellular Med, Newcastle Upon Tyne NE4 4HH, Tyne & Wear, England
[2] Newcastle Univ, Freeman Hosp, Adult Bronchiectasis Serv, Newcastle Upon Tyne NE4 4HH, Tyne & Wear, England
[3] Galway Univ Hosp, Dept Resp Med, Galway, Ireland
[4] Natl Univ Ireland, Lung Biol Grp, Galway, Ireland
[5] Univ Milan, Dept Pathophysiol & Transplantat, Milan, Italy
[6] Fdn IRCCS Ca Granda Osped Maggiore Policlin, Cardio Thorac Unit, Milan, Italy
[7] Fdn IRCCS Ca Granda Osped Maggiore Policlin, Cyst Fibrosis Adult Ctr, Milan, Italy
[8] Univ Hosp Gasthuisberg, Dept Resp Med, Leuven, Belgium
[9] AZ Nikolaas, Dept Resp Med, St Niklaas, Belgium
[10] Sotiria Chest Dis Hosp, Dept Pulm Med 5, Athens, Greece
[11] Univ Toronto, St Michaels Hosp, Keenan Res Ctr Biomed Sci, Dept Anesthesia, Toronto, ON, Canada
[12] Univ Dundee, Ninewells Hosp & Med Sch, Scottish Ctr Resp Res, Dundee, Scotland
[13] Univ Milano Bicocca, Clin Pneumolog, AO San Gerardo, Dept Hlth Sci, Monza, Italy
[14] Inst Pulm Dis Vojvodina Sremska Kamen, Put Doktora Goldmana 4, Sremska 4, Kamenica, Serbia
[15] Royal Brompton Hosp, Host Def Unit, London, England
[16] UK Imperial Coll, London, England
基金
英国惠康基金;
关键词
CYSTIC-FIBROSIS BRONCHIECTASIS; PREDICTING MORTALITY; ADULT PATIENTS; LUNG-FUNCTION; DRY POWDER; QUESTIONNAIRE; VALIDATION; INDEX; EXACERBATIONS; COLONIZATION;
D O I
10.1136/thoraxjnl-2016-208481
中图分类号
R56 [呼吸系及胸部疾病];
学科分类号
摘要
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.
引用
收藏
页码:1110 / 1118
页数:9
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