The bronchiectasis severity index. An international derivation and validation study

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

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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.

Original languageEnglish
Pages (from-to)576-85
Number of pages10
JournalAmerican Journal of Respiratory and Critical Care Medicine
Volume189
Issue number5
DOIs
Publication statusPublished - 1 Mar 2014

Keywords

  • Adult
  • Aged
  • Aged, 80 and over
  • Bronchiectasis
  • Decision Support Techniques
  • Disease Progression
  • Exercise Test
  • Female
  • Follow-Up Studies
  • Hospitalization
  • Humans
  • Male
  • Middle Aged
  • Prognosis
  • Proportional Hazards Models
  • Prospective Studies
  • Respiratory Function Tests
  • Risk Assessment
  • Risk Factors
  • Severity of Illness Index
  • Surveys and Questionnaires
  • Journal Article
  • Multicenter Study
  • Research Support, Non-U.S. Gov't
  • Validation Studies

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    Chalmers, J. D., Goeminne, P., Aliberti, S., McDonnell, M. J., Lonni, S., Davidson, J., Poppelwell, L., Salih, W., Pesci, A., Dupont, L. J., Fardon, T. C., De Soyza, A., & Hill, A. T. (2014). The bronchiectasis severity index. An international derivation and validation study. American Journal of Respiratory and Critical Care Medicine, 189(5), 576-85. https://doi.org/10.1164/rccm.201309-1575OC