Journal Article

The Bronchiectasis Severity Index. An International Derivation and Validation Study

Chalmers, James D., Poppelwell, Lucy, Lonni, Sara, Davidson, John, Hill, Adam T., Fardon, Thomas C., Dupont, Lieven J., Aliberti, Stefano, Pesci, Alberto, Goeminne, Pieter, McDonnell, Melissa J., Salih, Waleed, De Soyza, Anthony

2014

Overview

Abstract Rationale There are no risk stratification tools for morbidity and mortality in bronchiectasis. Identifying patients at risk of exacerbations, hospital admissions, and mortality is vital for future research. Objectives This study describes the derivation and validation of the Bronchiectasis Severity Index (BSI). Methods Derivation of the BSI used data from a prospective cohort study (Edinburgh, UK, 2008–2012) enrolling 608 patients. Cox proportional hazard regression was used to identify independent predictors of mortality and hospitalization over 4-year follow-up. The score was validated in independent cohorts from Dundee, UK (n = 218); Leuven, Belgium (n = 253); Monza, Italy (n = 105); and Newcastle, UK (n = 126). Measurements and Main Results Independent predictors of future hospitalization were prior hospital admissions, Medical Research Council dyspnea score greater than or equal to 4, FEV1 < 30% predicted, Pseudomonas aeruginosa colonization, colonization with other pathogenic organisms, and three or more lobes involved on high-resolution computed tomography. Independent predictors of mortality were older age, low FEV1, lower body mass index, prior hospitalization, and three or more exacerbations in the year before the study. The derived BSI predicted mortality and hospitalization: area under the receiver operator characteristic curve (AUC) 0.80 (95% confidence interval, 0.74–0.86) for mortality and AUC 0.88 (95% confidence interval, 0.84–0.91) for hospitalization, respectively. There was a clear difference in exacerbation frequency and quality of life using the St. George’s Respiratory Questionnaire between patients classified as low, intermediate, and high risk by the score (P < 0.0001 for all comparisons). In the validation cohorts, the AUC for mortality ranged from 0.81 to 0.84 and for hospitalization from 0.80 to 0.88. Conclusions The BSI is a useful clinical predictive tool that identifies patients at risk of future mortality, hospitalization, and exacerbations across healthcare systems.

• Publisher: Oxford University Press,American Thoracic Society
• Subject: Adult / Aged / Aged, 80 and over / Anesthesia. Intensive care medicine. Transfusions. Cell therapy and gene therapy / Antibiotics / Bacteriology / Biological and medical sciences / Bronchiectasis - diagnosis / Bronchiectasis - mortality / Bronchiectasis - therapy / Chronic obstructive pulmonary disease / Cohort analysis / Confidence intervals / Cystic fibrosis / Decision Support Techniques / Disease Progression / Exercise Test / Female / Follow-Up Studies / General aspects / Hospitalization / Hospitals / Human infectious diseases. Experimental studies and models / Humans / Infectious diseases / Intensive care medicine / Male / Medical prognosis / Medical sciences / Middle Aged / Mortality / Original / Patient admissions / Patient assessment / Pneumology / Prognosis / Proportional Hazards Models / Prospective Studies / Quality of life / Questionnaires / Respiratory Function Tests / Respiratory system : syndromes and miscellaneous diseases / Risk Assessment / Risk Factors / Severity of Illness Index / Surveys and Questionnaires / Tomography