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Predicting mortality in bronchiectasis using bronchiectasis severity index and FACED scores: a 19-year cohort study

Huw C. Ellis, Steven Cowman, Michele Fernandes, Robert Wilson, Michael R. Loebinger
European Respiratory Journal 2016 47: 482-489; DOI: 10.1183/13993003.01312-2015
Huw C. Ellis
1Host Defence Unit, Royal Brompton Hospital, London, UK
4These authors contributed equally to this paper
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Steven Cowman
1Host Defence Unit, Royal Brompton Hospital, London, UK
2Imperial College, London, UK
4These authors contributed equally to this paper
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Michele Fernandes
3St George's Medical School, London, UK
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Robert Wilson
1Host Defence Unit, Royal Brompton Hospital, London, UK
2Imperial College, London, UK
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Michael R. Loebinger
1Host Defence Unit, Royal Brompton Hospital, London, UK
2Imperial College, London, UK
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  • For correspondence: m.loebinger@rbht.nhs.uk
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  • FIGURE 1
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    FIGURE 1

    Kaplan–Maier curves for mortality during the study period corresponding to a) FACED score and b) bronchiectasis severity index score category.

  • FIGURE 2
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    FIGURE 2

    Receiver operating characteristic curves for bronchiectasis severity index (BSI) and FACED score for a) 5-, b) 10- and c) 15-year mortality.

Tables

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  • TABLE 1

    Demographics of study cohort

    Age years52.5±12.4
    FEV1 % predicted68.8±27.7
    BMI kg·m−223.4±3.9
    MRC dyspnoea score2.1±0.9
    Lobes affected3.4±1.5
    Exacerbations in previous year4.4±4.4
    Hospitalisations in last 2 years0.5±1.3
    Microbiological colonisation status
     Pseudomonas aeruginosa16 (22)
     Haemophilus influenzae9 (12)
     Streptococcus pneumoniae3 (4)
     Staphylococcus aureus1 (1)
     Branhamella catarrhalis1 (1)
    Aetiology of bronchiectasis
     Idiopathic41 (55)
     Post-infective19 (26)
     Allergic bronchopulmonary aspergillosis5 (7)
     Young's syndrome4 (5)
     Common variable immunodeficiency3 (4)
     Primary ciliary dyskinesia2 (3)
    • Data are presented as mean±sd or n (%). FEV1: forced expiratory volume in 1 s; BMI: body mass index; MRC: Medical Research Council.

  • TABLE 2

    Classification of subjects by bronchiectasis severity index (BSI) and FACED scores

    BSIFACED
    MildModerateSevere
    Mild1711
    Moderate21101
    Severe1184
    • Data are presented as n.

  • TABLE 3

    Contribution of individual variables to FACED and bronchiectasis severity index (BSI) scores

     FACED scoreBSI score
    Mild
    (0–2)
    Moderate
    (3–4)
    Severe
    (5–7)
    Mild
    (0–4)
    Moderate
    (5–8)
    Severe
    (9+)
    Age years
     <5022 (45)8 (42)1 (22)11 (58)14 (44)7 (30)
     50–6925 (51)8 (42)3 (50)8 (42)14 (44)13 (57)
     70–792 (4)3 (16)2 (33)0 (0)4 (13)3 (13)
     ≥800 (0)0 (0)0 (0)0 (0)0 (0)0 (0)
    FEV1 % predicted
     <302 (4)3 (16)2 (33)1 (5)4 (13)2 (9)
     30–492 (4)12 (63)3 (50)2 (11)9 (28)7 (30)
     50–8018 (37)3 (16)1 (22)4 (21)9 (28)10 (43)
     >8027 (55)1 (5)0 (0)12 (63)10 (31)4 (17)
    BMI kg·m−2
     <18.51 (2)2 ((11)0 (0)0 (0)0 (0)3 (13)
     18.5–2536 (73)15 (79)5 (87)15 (79)24 (75)15 (65)
     26–309 (18)1 (5)0 (0)3 (16)6 (19)3 (13)
     >303 (6)1 (5)1 (22)1 (5)2 (6)2 (6)
    MRC dyspnoea score
     0–236 (73)12 (63)0 (0)15 (79)25 (78)8 (35)
     311 (22)7 (37)4 (66)4 (21)7 (22)11 (48)
     42 (4)0 (0)2 (33)0 (0)0 (0)4 (17)
     50 (0)0 (0)0 (0)0 (0)0 (0)0 (0)
    Lobes affected
     16 (12)1 (5)0 (0)3 (16)2 (6)2 (6)
     216 (33)3 (16)0 (0)5 (26)8 (25)6 (26)
     ≥3 or cystic bronchiectasis27 (55)15 (79)6 (100)11 (58)22 (69)15 (65)
    Exacerbations in previous year
     03 (6)2 (11)1 (22)3 (16)3 (9)0 (0)
     1–217 (35)5 (26)3 (50)13 (68)7 (22)6 (26)
     ≥329 (59)12 (63)2 (33)3 (16)22 (69)17 (74)
    Hospitalisations in last 2 years
     Yes15 (31)3 (16)1 (22)0 (0)7 (22)12 (52)
     No34 (69)16 (84)5 (87)19 (100)25 (78)11 (48)
    Microbiological colonisation status
     Pseudomonas aeruginosa6 (12)5 (26)5 (83)1 (5)7 (22)8 (35)
     Haemophilus influenzae6 (12)3 (16%)0 (0)2 (11)5 (16)2 (9)
     Streptococcus pneumoniae2 (4)1 (5)0 (0)0 (0)3 (9)0 (0)
     Staphylococcus aureus1 (2)0 (0)0 (0)1 (5)0 (0)0 (0)
     Branhamella catarrhalis1 (2)0 (0)0 (0)1 (5)0 (0)0 (0)
     None33 (67)10 (53)1 (17)14 (74)27 (84)13 (57)
    • Data are presented as n (%). FEV1: forced expiratory volume in 1 s; BMI: body mass index; MRC: Medical Research Council.

  • TABLE 4

    Univariate Cox proportional hazard analysis of bronchiectasis severity index (BSI) and FACED scores for mortality during the study period according to BSI and FACED category

    Subjects
    n
    Mortality
    n (%)
    Hazard ratio
    (95% CI)
    p-value
    BSI
     Mild194 (21%)Reference
     Moderate329 (28%)1.40 (0.43–4.54)0.577
     Severe2313 (57%)3.66 (1.19–11.24)0.023
    FACED
     Mild498 (16%)Reference 
     Moderate1913 (68%)5.90 (2.43–14.32)<0.001
     Severe65 (83%)12.49 (3.98–39.18)<0.001
  • TABLE 5

    Comparison of receiver operating characteristics (ROCs) for mortality at different time points between bronchiectasis severity index (BSI) and FACED scores

    MortalityBSIFACEDp-value
    5-year0.79 (0.64–0.94)0.80 (0.65–0.95)0.876
    10-year0.71 (0.55–0.86)0.84 (0.72–0.95)0.082
    15-year0.69 (0.55–0.82)0.82 (0.72–0.93)0.049
    • Data are presented as area under the curve (95% CI), unless otherwise stated. p-values calculated using DeLong's test for two correlated ROC curves.

Additional Files

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    Please note: supplementary material is not edited by the Editorial Office, and is uploaded as it has been supplied by the author.

    • Supplementary tables S1 and S2
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Predicting mortality in bronchiectasis using bronchiectasis severity index and FACED scores: a 19-year cohort study
Huw C. Ellis, Steven Cowman, Michele Fernandes, Robert Wilson, Michael R. Loebinger
European Respiratory Journal Feb 2016, 47 (2) 482-489; DOI: 10.1183/13993003.01312-2015

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Predicting mortality in bronchiectasis using bronchiectasis severity index and FACED scores: a 19-year cohort study
Huw C. Ellis, Steven Cowman, Michele Fernandes, Robert Wilson, Michael R. Loebinger
European Respiratory Journal Feb 2016, 47 (2) 482-489; DOI: 10.1183/13993003.01312-2015
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