Comparison of two prognostic scores (BSI and FACED) in a Spanish cohort of adult patients with bronchiectasis and improvement of the FACED predictive capacity for exacerbations

Abstract

Bronchiectasis (BE) is a chronic and heterogeneous respiratory disease that requires a multidimensional scoring system to properly assess severity. The aim of this study was to compare the severity stratification by 2 validated scores (BSI and FACED) in a BE cohort and to determine their predictive capacity for exacerbations and hospitalizations. Moreover, we proposed a modified version of FACED which was created to better predict the risk of exacerbations in clinical practice. We performed a prospective cohort study including BE patients >18 years old with a follow-up period of 1-year. One-hundred eighty-two patients (40% males; mean age 68) were studied. Patients were stratified according to the number of exacerbations during the follow-up, and according to BSI and FACED scores. BSI classified most of our patients as severe 99 (54.4%) or moderate 47 (25.8%), while FACED mainly classified as mild 108 (59.3%) or moderate 61 (33.5%). BSI and FACED showed an area under ROC curve (AUC) for exacerbations of 0.808 and 0.734; and for hospitalizations (due to BE exacerbations) of 0.893 and 0.809, respectively. Subsequently, we modified FACED by adding previous exacerbations (Exa-FACED) and this new score classified patients as mild 48.4%, moderate 34.6% and severe 17.0%, with an improved AUC for exacerbations (0.760) and hospitalizations (0.820). Despite previous validations of BSI and FACED, they classified our patients very differently. As expected, FACED showed poor prognostic capacity for exacerbations. We support the Exa-FACED score to predict the risk future exacerbations for been easy to use in clinical practice.

Characterization of the “Frequent Exacerbator Phenotype” in Bronchiectasis

“…(7) Several recent comparisons between the BSI and the similar FACED score found that FACED did not accurately predict future risk of exacerbations suggesting that it was not a valid predictor of severity of disease. (16,32) The major difference between the scores is that BSI incorporates history of exacerbations which are not included in FACED. (16,32) Modification of the FACED to include a past history of exacerbations has been shown to improve its prediction of exacerbations.…”

Severidad de bronquiectasias en pacientes adultos con inmunodeficiencia común variable

“…Por ello, es una escala que debería aplicarse de forma sistemática para los pacientes con IDCV y bronquiectasias. 6,18,19…”

The challenge of defining exacerbation in bronchiectasis

“…It is also just as difficult to establish the specific parameters that must be used to define an exacerbation; parameters that are usually grouped as symptoms and/or factors involving the use of health resources or a need for treatment. Nevertheless, in the case of bronchiectasis, and other respiratory diseases, exacerbations ( particularly severe exacerbations) have a demonstrable negative impact on a patient's prognosis [1][2][3][4] and entail great expense [5,6], and so their identification, and therefore their definition, is crucial to any early detection and treatment. Ideally, such a definition should present a perfect diagnostic value and, as regards bronchiectasis, be based on reproducible objective measurements linked to inflammation/bronchial infection (biomarkers) and their consequences (acute clinical symptoms).…”

“…One important point, fully explained by the authors, is that this is a definition for use in research, as it may have a high specificity (little probability of identifying exacerbations that are not in fact exacerbations). This leads to selection bias towards more severe exacerbations, although in a research context it is preferable to err in this direction as it is the severe forms that most seem to affect a patient's prognosis [1][2][3][4], and they are thus the most appropriate target or inclusion criterion for clinical studies. However, the definition does incorporate a number of symptomatic elements, and the need to change treatment (in this case, to prescribe antibiotics), which may contribute towards a better balance between sensitivity and specificity.…”