Abstract
Background: Bronchiectasis is a multidimensional lung disease characterized by bronchial dilation, chronic inflammation, and infection. The FACED (Forced expiratory volume in 1 s (FEV1), Age, Chronic colonization, Extension, and Dyspnea) score and Bronchiectasis Severity Index (BSI) are used to stratify disease risk and guide clinical practice. This meta-analysis aimed to quantify the accuracy of these two systems for predicting bronchiectasis outcomes.Methods: PubMed, Embase, and the Cochrane Database of Systematic Reviews were searched for relevant studies. Quality of included studies was assessed using the Quality Assessment of Diagnostic Accuracy Studies-2 (QUADAS-2) criteria. Pooled summary estimates, including sensitivity, specificity, positive likelihood ratio (PLR), negative likelihood ratio (NLR), and diagnostic odds ratio (DOR) were calculated. Summary receiver operating characteristic curves were constructed, and the area under the curve (AUC) was used to evaluate prognostic performance.Results: We analyzed 17 unique cohorts (6525 participants) from ten studies. FACED scores with a cut-off value ≥ 5 predicted all-cause mortality better than BSI with a cut-off value ≥ 9, based on pooled sensitivity (0.34 vs 0.7), specificity (0.94 vs 0.66), PLR (4.76 vs 2.05), NLR (0.74 vs 0.48), DOR (6.67 vs 5.01), and AUC (0.87 vs 0.75). Both FACED scores with a cut-off value ≥ 5 (AUC = 0.82) and BSI scores with a cut-off value ≥ 5 or 9 (both AUC = 0.80) help to predict hospitalization.Conclusions: At a cut-off value ≥ 5, FACED scores can reliably predict all-cause mortality and hospitalization, while BSI scores can reliably predict hospitalization with a cut-off of ≥5 or ≥9. Further studies are essential to validate the prognostic performance of these two scores.
Highlights
Bronchiectasis is a chronic inflammatory and structural lung disease characterized by chronic dilation of the bronchi; clinical symptoms of the disease include persistent cough, sputum production, and recurrent respiratory infections [1,2]
The forced expiratory volume in s (FACED) score at a cut-off value ≥ 5 had good predictive accuracy based on the pooled sensitivity (0.34, 95% confidence interval [CI] = 0.3–0.38), specificity (0.94, 95% CI = 0.93–0.95), positive likelihood ratio (PLR) (4.76, 95% CI = 3.48–6.51), negative likelihood ratio (NLR) (0.74, 95% CI = 0.62–0.88), and diagnostic odds ratio (DOR) (6.67, 95% CI = 4.25–10.45)
Based on the area under the curve (AUC) values, we found that the FACED score was better at predicting all-cause mortality than the Bronchiectasis Severity Index (BSI) score (0.87 vs 0.75; Figures 3 and 4)
Summary
Bronchiectasis is a chronic inflammatory and structural lung disease characterized by chronic dilation of the bronchi; clinical symptoms of the disease include persistent cough, sputum production, and recurrent respiratory infections [1,2]. The FACED (Forced expiratory volume in 1 s (FEV1), Age, Chronic colonization, Extension, and Dyspnea) score and Bronchiectasis Severity Index (BSI) are used to stratify disease risk and guide clinical practice. This meta-analysis aimed to quantify the accuracy of these two systems for predicting bronchiectasis outcomes. FACED scores with a cut-off value ≥ 5 predicted all-cause mortality better than BSI with a cut-off value ≥ 9, based on pooled sensitivity (0.34 vs 0.7), specificity (0.94 vs 0.66), PLR (4.76 vs 2.05), NLR (0.74 vs 0.48), DOR (6.67 vs 5.01), and AUC (0.87 vs 0.75). Further studies are essential to validate the prognostic performance of these two scores
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