title: Multidimensional severity assessment in bronchiectasis: an analysis of seven European cohorts.
abstract: 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 of which stratify patients into severity risk categories to predict the probability of mortality.
  
  
  
  We aimed to compare the predictive utility of BSI and FACED in assessing clinically relevant disease outcomes across seven European cohorts independent of their original validation studies.
  
  
  
  The combined cohorts totalled 1612. Pooled analysis showed that both scores had a good discriminatory predictive value for mortality (pooled area under the curve (AUC) 0.76, 95% CI 0.74 to 0.78 for both scores) with the BSI demonstrating a higher sensitivity (65% vs 28%) but lower specificity (70% vs 93%) compared with the FACED score. Calibration analysis suggested that the BSI performed consistently well across all cohorts, while FACED consistently overestimated mortality in 'severe' patients (pooled OR 0.33 (0.23 to 0.48), p<0.0001). The BSI accurately predicted hospitalisations (pooled AUC 0.82, 95% CI 0.78 to 0.84), exacerbations, quality of life (QoL) and respiratory symptoms across all risk categories. FACED had poor discrimination for hospital admissions (pooled AUC 0.65, 95% CI 0.63 to 0.67) with low sensitivity at 16% and did not consistently predict future risk of exacerbations, QoL or respiratory symptoms. No association was observed with FACED and 6 min walk distance (6MWD) or lung function decline.
  
  
  
  The BSI accurately predicts mortality, hospital admissions, exacerbations, QoL, respiratory symptoms, 6MWD and lung function decline in bronchiectasis, providing a clinically relevant evaluation of disease severity.
authors: Department of Respiratory Medicine, Galway University Hospitals, Galway, Ireland.|Institute of Cellular Medicine and Adult Bronchiectasis Service, Freeman Hospital, Newcastle University, Newcastle-upon-Tyne, UK.|Lung Biology Group, National University of Ireland, Galway, Ireland.
authors: M J
authors: MJ
authors: McDonnell
authors: Department of Pathophysiology and Transplantation, University of Milan, Milan, Italy.|Cardio-thoracic Unit and Cystic Fibrosis Adult Center, Fondazione IRCCS Cà Granda Ospedale Maggiore Policlinico, Milan, Italy.
authors: S
authors: S
authors: Aliberti
authors: Department of Respiratory Medicine, University Hospital Gasthuisberg, Leuven, Belgium.|Department of Respiratory Medicine, AZ Nikolaas, Sint-Niklaas, Belgium.
authors: P C
authors: PC
authors: Goeminne
authors: Fifth Department of Pulmonary Medicine, "Sotiria" Chest Diseases Hospital, Athens, Greece.
authors: K
authors: K
authors: Dimakou
authors: Department of Pathophysiology and Transplantation, University of Milan, Milan, Italy.|Cardio-thoracic Unit and Cystic Fibrosis Adult Center, Fondazione IRCCS Cà Granda Ospedale Maggiore Policlinico, Milan, Italy.
authors: S C
authors: SC
authors: Zucchetti
authors: Institute of Cellular Medicine and Adult Bronchiectasis Service, Freeman Hospital, Newcastle University, Newcastle-upon-Tyne, UK.
authors: J
authors: J
authors: Davidson
authors: Institute of Cellular Medicine and Adult Bronchiectasis Service, Freeman Hospital, Newcastle University, Newcastle-upon-Tyne, UK.
authors: C
authors: C
authors: Ward
authors: Lung Biology Group, National University of Ireland, Galway, Ireland.|Department of Anesthesia, Keenan Research Centre for Biomedical Science, St Michael's Hospital, University of Toronto, Toronto, Ontario, Canada.
authors: J G
authors: JG
authors: Laffey
authors: Scottish Centre for Respiratory Research, University of Dundee, Ninewells Hospital and Medical School, Dundee, UK.
authors: S
authors: S
authors: Finch
authors: Department of Health Science, University of Milan Bicocca, Clinica Pneumologica, AO San Gerardo, Monza, Italy.
authors: A
authors: A
authors: Pesci
authors: Department of Respiratory Medicine, University Hospital Gasthuisberg, Leuven, Belgium.
authors: L J
authors: LJ
authors: Dupont
authors: Scottish Centre for Respiratory Research, University of Dundee, Ninewells Hospital and Medical School, Dundee, UK.
authors: T C
authors: TC
authors: Fardon
authors: Institute for Pulmonary Diseases of Vojvodina Sremska Kamenica, Put doktora Goldmana 4, Sremska Kamenica, Serbia.
authors: D
authors: D
authors: Skrbic
authors: Institute for Pulmonary Diseases of Vojvodina Sremska Kamenica, Put doktora Goldmana 4, Sremska Kamenica, Serbia.
authors: D
authors: D
authors: Obradovic
authors: Host Defence Unit, Royal Brompton Hospital and UK Imperial College, London, UK.
authors: S
authors: S
authors: Cowman
authors: Host Defence Unit, Royal Brompton Hospital and UK Imperial College, London, UK.
authors: M R
authors: MR
authors: Loebinger
authors: Department of Respiratory Medicine, Galway University Hospitals, Galway, Ireland.
authors: R M
authors: RM
authors: Rutherford
authors: Institute of Cellular Medicine and Adult Bronchiectasis Service, Freeman Hospital, Newcastle University, Newcastle-upon-Tyne, UK.
authors: A
authors: A
authors: De Soyza
authors: Scottish Centre for Respiratory Research, University of Dundee, Ninewells Hospital and Medical School, Dundee, UK.
authors: J D
authors: JD
authors: Chalmers
mesh_terms: D000368:Aged; D001987:Bronchiectasis / Q000175:diagnosis* / Q000401:mortality / Q000503:physiopathology; D018450:Disease Progression; D005060:Europe / Q000453:epidemiology; D005260:Female; D005500:Follow-Up Studies; D005541:Forced Expiratory Volume / Q000502:physiology; D006760:Hospitalization / Q000706:statistics & numerical data; D006801:Humans; D008297:Male; D008875:Middle Aged; D011237:Predictive Value of Tests; D011379:Prognosis; D011788:Quality of Life; D018570:Risk Assessment / Q000379:methods; D012720:Severity of Illness Index
keywords: Bronchiectasis; Respiratory Infection