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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

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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.

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ROC curve for ≥2 exacerbations at 1-year of follow-up.Abbreviations: Sens = sensitivity; Spec = specificity; PPV = positive predictive value; NPV = negative predictive value; GV: global value; LR+ = positive likelihood ratio; LR- = negative likehood ratio; OR = odds ratio; NA = non-available.
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pone.0175171.g001: ROC curve for ≥2 exacerbations at 1-year of follow-up.Abbreviations: Sens = sensitivity; Spec = specificity; PPV = positive predictive value; NPV = negative predictive value; GV: global value; LR+ = positive likelihood ratio; LR- = negative likehood ratio; OR = odds ratio; NA = non-available.

Mentions: The discrimination of each score to predict exacerbations (≥2/year) or hospitalizations (≥1/year) are shown in Figs 1 and 2. The AUC was 0.808 (95%CI 0.734–0.882) for BSI and 0.734 (95%CI 0.648–0.821) for FACED regarding exacerbations (p = 0.023 for BSI vs FACED). We observed a higher sensitivity of BSI in contrast with a higher specificity of FACED using FACED≥3 and BSI≥5 as cut-off points (moderate and severe classes).


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
ROC curve for ≥2 exacerbations at 1-year of follow-up.Abbreviations: Sens = sensitivity; Spec = specificity; PPV = positive predictive value; NPV = negative predictive value; GV: global value; LR+ = positive likelihood ratio; LR- = negative likehood ratio; OR = odds ratio; NA = non-available.
© Copyright Policy
Related In: Results  -  Collection

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getmorefigures.php?uid=PMC5383257&req=5

pone.0175171.g001: ROC curve for ≥2 exacerbations at 1-year of follow-up.Abbreviations: Sens = sensitivity; Spec = specificity; PPV = positive predictive value; NPV = negative predictive value; GV: global value; LR+ = positive likelihood ratio; LR- = negative likehood ratio; OR = odds ratio; NA = non-available.
Mentions: The discrimination of each score to predict exacerbations (≥2/year) or hospitalizations (≥1/year) are shown in Figs 1 and 2. The AUC was 0.808 (95%CI 0.734–0.882) for BSI and 0.734 (95%CI 0.648–0.821) for FACED regarding exacerbations (p = 0.023 for BSI vs FACED). We observed a higher sensitivity of BSI in contrast with a higher specificity of FACED using FACED≥3 and BSI≥5 as cut-off points (moderate and severe classes).

View Article: PubMed Central - PubMed

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.

No MeSH data available.


Related in: MedlinePlus