The Bronchiectasis Severity Index. An International Derivation and Validation Study
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- 1 March 2014
- journal article
- research article
- Published by American Thoracic Society in American Journal of Respiratory and Critical Care Medicine
- Vol. 189 (5), 576-585
- https://doi.org/10.1164/rccm.201309-1575oc
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.Keywords
This publication has 29 references indexed in Scilit:
- British Thoracic Society guideline for non-CFbronchiectasisThorax, 2010
- Mortality in bronchiectasis: a long-term study assessing the factors influencing survivalEuropean Respiratory Journal, 2009
- Analysis of the factors related to mortality in patients with bronchiectasisRespiratory Medicine, 2007
- Nontuberculous mycobacteria in bronchiectasis: prevalence and patient characteristicsEuropean Respiratory Journal, 2006
- High-resolution computed tomography in young patients with cystic fibrosis: Distribution of abnormalities and correlation with pulmonary function testsThe Journal of Pediatrics, 2004
- An Investigation into Causative Factors in Patients with BronchiectasisAmerican Journal of Respiratory and Critical Care Medicine, 2000
- Validation of the St. George's Respiratory Questionnaire in BronchiectasisAmerican Journal of Respiratory and Critical Care Medicine, 1997
- CT findings in bronchiectasis: limited value in distinguishing between idiopathic and specific types.American Journal of Roentgenology, 1995
- Cystic fibrosis: scoring system with thin-section CT.Radiology, 1991
- Index for rating diagnostic testsCancer, 1950