Predicting high risk of exacerbations in bronchiectasis: the E-FACED score.
BACKGROUND
Although the FACED score has demonstrated a great prognostic capacity in bronchiectasis, it does not include the number or severity of exacerbations as a separate variable, which is important in the natural history of these patients.


OBJECTIVE
Construction and external validation of a new index, the E-FACED, to evaluate the predictive capacity of exacerbations and mortality.


METHODS
The new score was constructed on the basis of the complete cohort for the construction of the original FACED score, while the external validation was undertaken with six cohorts from three countries (Brazil, Argentina, and Chile). The main outcome was the number of annual exacerbations/hospitalizations, with all-cause and respiratory-related deaths as the secondary outcomes. A statistical evaluation comprised the relative weight and ideal cut-off point for the number or severity of the exacerbations and was incorporated into the FACED score (E-FACED). The results obtained after the application of FACED and E-FACED were compared in both the cohorts.


RESULTS
A total of 1,470 patients with bronchiectasis (819 from the construction cohorts and 651 from the external validation cohorts) were followed up for 5 years after diagnosis. The best cut-off point was at least two exacerbations in the previous year (two additional points), meaning that the E-FACED has nine points of growing severity. E-FACED presented an excellent prognostic capacity for exacerbations (areas under the receiver operating characteristic curve: 0.82 for at least two exacerbations in 1 year and 0.87 for at least one hospitalization in 1 year) that was statistically better than that of the FACED score (0.72 and 0.78,P<0.05, respectively). The predictive capacities for all-cause and respiratory mortality were 0.87 and 0.86, respectively, with both being similar to those of the FACED.


CONCLUSIONS
E-FACED score significantly increases the FACED capacity to predict future yearly exacerbations while maintaining the score's simplicity and prognostic capacity for death.
Pulmonary Service, Polytechnic and University La Fe Hospital, Valencia, Spain; CIBERes, CIBER de Enfermedades Respiratorias. Madrid. Spain.
M A
MA
Martinez-Garcia
Pulmonary Division, Heart Institute (Incor), Hospital das Clínicas da Faculdadede Medicina da Universidade de São Paulo.
R A
RA
Athanazio
Pneumology Service, Hospital La Princesa.
R
R
Girón
Pneumology Service, Hospital Ramón y Cajal, Madrid.
L
L
Máiz-Carro
Pneumology Unit, Hospital Plató, Barcelona.
D
D
de la Rosa
Pneumology, Málaga Regional University Hospital, Instituto de Biomedicina de Málaga (IBIMA), Málaga University, Spain.
C
C
Olveira
CIBERes, CIBER de Enfermedades Respiratorias. Madrid. Spain; Pneumology Service, Hospital Vall d'Hebron, Barcelona.
J
J
de Gracia
Bronchiectasis Group IDIBGI, Dr. Trueta University Hospital. UdG. Ciberes CB06/06/0030.
M
M
Vendrell
Unidad de Fibrosis Quística y Bronquiectasias. Hospital Universitario La Paz. Madrid. Spain.
C
C
Prados-Sánchez
Pneumology Service, Hospital del Tórax Dr A Cetrángolo, Buenos Aires, Argentina.
G
G
Gramblicka
Pneumology Service, Universidade Estadual de Campinas UNICAMP, Sao Paulo.
M
M
Corso Pereira
Pneumology Service, Hospital Octávio de Freitas, Recife.
F L
FL
Lundgren
Pneumology Service, Hospital de Messejana, Fortaleza, Brazil.
M
M
Fernandes De Figueiredo
Pneumology Service, Instituto Nacional del Tórax, Santiago de Chile, Chile.
F
F
Arancibia
Pulmonary Division, Heart Institute (Incor), Hospital das Clínicas da Faculdadede Medicina da Universidade de São Paulo.
S Z
SZ
Rached
D000328:Adult; D000367:Age Factors; D000368:Aged; D019540:Area Under Curve; D001118:Argentina; D001938:Brazil; D001987:Bronchiectasis / Q000175:diagnosis* / Q000401:mortality / Q000503:physiopathology / Q000628:therapy; D002423:Cause of Death; D002677:Chile; D018450:Disease Progression; D004417:Dyspnea / Q000503:physiopathology; D005260:Female; D005541:Forced Expiratory Volume; D006304:Health Status; D006305:Health Status Indicators; D006760:Hospitalization; D006801:Humans; D008168:Lung / Q000382:microbiology / Q000503:physiopathology*; D008297:Male; D008875:Middle Aged; D011237:Predictive Value of Tests; D011552:Pseudomonas Infections / Q000175:diagnosis / Q000382:microbiology; D011550:Pseudomonas aeruginosa / Q000302:isolation & purification; D012372:ROC Curve; D015203:Reproducibility of Results; D012141:Respiratory Tract Infections / Q000175:diagnosis / Q000382:microbiology; D012307:Risk Factors; D012720:Severity of Illness Index; D013997:Time Factors
E-FACED score; FACED score; bronchiectasis; exacerbations; mortality