Data di Pubblicazione:
2014
Citazione:
The bronchiectasis severity index : an international derivation and validation study / J.D. Chalmers, P. Goeminne, S. Aliberti, M.J. Mcdonnell, S. Lonni, J. Davidson, L. Poppelwell, W. Salih, A. Pesci, L.J. Dupont, T.C. Fardon, A. De Soyza, A.T. Hill. - In: AMERICAN JOURNAL OF RESPIRATORY AND CRITICAL CARE MEDICINE. - ISSN 1073-449X. - 189:5(2014 Mar), pp. 576-585. [10.1164/rccm.201309-1575OC]
Abstract:
Rationale: There are no risk stratification tools for morbidity and mortality in bronchiectasis. Identifying patients at risk of exacerbations, hospital admissions, and mortality is vital for future research. Objectives: This study describes the derivation and validation of the Bronchiectasis Severity Index (BSI). Methods: Derivationof theBSI used data fromaprospective cohort study (Edinburgh, UK, 2008-2012) enrolling 608 patients. Cox proportional hazard regression was used to identify independent predictors of mortality and hospitalization over 4-year follow-up. The score was validated in independent cohorts from Dundee, UK (n = 218); Leuven, Belgium (n = 253);Monza, Italy (n = 105); and Newcastle, UK (n = 126). Measurements and Main Results: Independent predictors of future hospitalization were prior hospital admissions, Medical Research Council dyspnea score greater than or equal to 4, FEV1 , 30% predicted, Pseudomonas aeruginosa colonization, colonization with other pathogenic organisms, and three or more lobes involved on high-resolution computed tomography. Independent predictors of mortality were older age, low FEV1, lower body mass index, prior hospitalization, and three or more exacerbations in the year before the study. The derived BSI predicted mortality and hospitalization: area under the receiver operator characteristic curve (AUC) 0.80 (95% confidence interval, 0.74-0.86) for mortality and AUC 0.88 (95% confidence interval, 0.84-0.91) for hospitalization, respectively. Therewas a clear difference in exacerbation frequency and quality of life using the St. George's Respiratory Questionnaire between patients classified as low, intermediate, and high risk by the score (P<0.0001 for all comparisons). In the validation cohorts, the AUC for mortality ranged from 0.81 to 0.84 and for hospitalization from 0.80 to 0.88. Conclusions: The BSI is a useful clinical predictive tool that identifies patients at risk of future mortality, hospitalization, and exacerbations across healthcare systems.
Tipologia IRIS:
01 - Articolo su periodico
Keywords:
Bronchiectasis; Exacerbation; Mortality; Prediction; Pseudomonas aeruginosa; Adult; Aged; Aged, 80 and over; Bronchiectasis; Disease Progression; Exercise Test; Female; Follow-Up Studies; Hospitalization; Humans; Male; Middle Aged; Prognosis; Proportional Hazards Models; Prospective Studies; Respiratory Function Tests; Risk Assessment; Risk Factors; Surveys and Questionnaires; Decision Support Techniques; Severity of Illness Index; Pulmonary and Respiratory Medicine; Critical Care and Intensive Care Medicine
Elenco autori:
J.D. Chalmers, P. Goeminne, S. Aliberti, M.J. Mcdonnell, S. Lonni, J. Davidson, L. Poppelwell, W. Salih, A. Pesci, L.J. Dupont, T.C. Fardon, A. De Soyza, A.T. Hill
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