Multidimensional severity assessment in bronchiectasis - An analysis of 7 European cohorts

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 stratify patients into risk categories to predict the probability of mortality. Methods: We compared the predictive utility of the BSI and FACED score in assessing clinically relevant outcomes across 7 European cohorts independent of their original validation studies. Results: Combined cohorts totalled 1,612 patients. Pooled analysis showed that both scores had a good discriminatory predictive value for mortality with the BSI demonstrating a higher sensitivity. Calibration analysis suggested that the BSI performed consistently well across all cohorts, while FACED overestimated mortality in “severe” patients and stratified a quarter of patients dying or hospitalised for severe exacerbations as “mild/moderate” disease. The BSI accurately predicted hospitalisations, exacerbations, quality of life (QoL) and respiratory symptoms across all risk categories and was significantly associated with 6-minute walk distance (6MWD) and lung function decline. FACED consistently had a sensitivity of Conclusion: The BSI accurately predicts mortality, hospitalisations, exacerbations, QoL, respiratory symptoms, 6MWD and lung function decline in bronchiectasis, providing a clinically relevant evaluation of disease severity that goes beyond mortality risk.