The bronchiectasis severity index. An international derivation and validation study

James D Chalmers; Pieter Goeminne; Stefano Aliberti; Melissa J McDonnell; Sara Lonni; John Davidson; Lucy Poppelwell; Waleed Salih; Alberto Pesci; Lieven J Dupont; Thomas C Fardon; Anthony De Soyza; Adam T Hill

doi:10.1164/rccm.201309-1575OC

The bronchiectasis severity index. An international derivation and validation study

James D Chalmers, Pieter Goeminne, Stefano Aliberti, Melissa J McDonnell, Sara Lonni, John Davidson, Lucy Poppelwell, Waleed Salih, Alberto Pesci, Lieven J Dupont, Thomas C Fardon, Anthony De Soyza, Adam T Hill

Research output: Contribution to journal › Article › peer-review

Abstract / Description of output

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: Derivation of the BSI used data from a prospective 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. There was 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.

Original language	English
Pages (from-to)	576-85
Number of pages	10
Journal	American Journal of Respiratory and Critical Care Medicine
Volume	189
Issue number	5
DOIs	https://doi.org/10.1164/rccm.201309-1575OC
Publication status	Published - 1 Mar 2014

Keywords / Materials (for Non-textual outputs)

Adult
Aged
Aged, 80 and over
Bronchiectasis
Decision Support Techniques
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
Severity of Illness Index
Surveys and Questionnaires

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10.1164/rccm.201309-1575OC

Cite this

Chalmers, J. D., Goeminne, P., Aliberti, S., McDonnell, M. J., Lonni, S., Davidson, J., Poppelwell, L., Salih, W., Pesci, A., Dupont, L. J., Fardon, T. C., De Soyza, A., & Hill, A. T. (2014). The bronchiectasis severity index. An international derivation and validation study. American Journal of Respiratory and Critical Care Medicine, 189(5), 576-85. https://doi.org/10.1164/rccm.201309-1575OC

@article{20438764d978499cae9f00d06766f160,

title = "The bronchiectasis severity index. An international derivation and validation study",

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: Derivation of the BSI used data from a prospective 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. There was 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.",

keywords = "Adult, Aged, Aged, 80 and over, Bronchiectasis, Decision Support Techniques, 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, Severity of Illness Index, Surveys and Questionnaires",

author = "Chalmers, {James D} and Pieter Goeminne and Stefano Aliberti and McDonnell, {Melissa J} and Sara Lonni and John Davidson and Lucy Poppelwell and Waleed Salih and Alberto Pesci and Dupont, {Lieven J} and Fardon, {Thomas C} and {De Soyza}, Anthony and Hill, {Adam T}",

year = "2014",

month = mar,

day = "1",

doi = "10.1164/rccm.201309-1575OC",

language = "English",

volume = "189",

pages = "576--85",

journal = "American Journal of Respiratory and Critical Care Medicine",

issn = "1073-449X",

publisher = "American Thoracic Society",

number = "5",

}

Chalmers, JD, Goeminne, P, Aliberti, S, McDonnell, MJ, Lonni, S, Davidson, J, Poppelwell, L, Salih, W, Pesci, A, Dupont, LJ, Fardon, TC, De Soyza, A & Hill, AT 2014, 'The bronchiectasis severity index. An international derivation and validation study', American Journal of Respiratory and Critical Care Medicine, vol. 189, no. 5, pp. 576-85. https://doi.org/10.1164/rccm.201309-1575OC

TY - JOUR

T1 - The bronchiectasis severity index. An international derivation and validation study

AU - Chalmers, James D

AU - Goeminne, Pieter

AU - Aliberti, Stefano

AU - McDonnell, Melissa J

AU - Lonni, Sara

AU - Davidson, John

AU - Poppelwell, Lucy

AU - Salih, Waleed

AU - Pesci, Alberto

AU - Dupont, Lieven J

AU - Fardon, Thomas C

AU - De Soyza, Anthony

AU - Hill, Adam T

PY - 2014/3/1

Y1 - 2014/3/1

N2 - 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: Derivation of the BSI used data from a prospective 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. There was 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.

AB - 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: Derivation of the BSI used data from a prospective 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. There was 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.

KW - Adult

KW - Aged

KW - Aged, 80 and over

KW - Bronchiectasis

KW - Decision Support Techniques

KW - Disease Progression

KW - Exercise Test

KW - Female

KW - Follow-Up Studies

KW - Hospitalization

KW - Humans

KW - Male

KW - Middle Aged

KW - Prognosis

KW - Proportional Hazards Models

KW - Prospective Studies

KW - Respiratory Function Tests

KW - Risk Assessment

KW - Risk Factors

KW - Severity of Illness Index

KW - Surveys and Questionnaires

U2 - 10.1164/rccm.201309-1575OC

DO - 10.1164/rccm.201309-1575OC

M3 - Article

C2 - 24328736

SN - 1073-449X

VL - 189

SP - 576

EP - 585

JO - American Journal of Respiratory and Critical Care Medicine

JF - American Journal of Respiratory and Critical Care Medicine

IS - 5

ER -

The bronchiectasis severity index. An international derivation and validation study

Abstract / Description of output

Keywords / Materials (for Non-textual outputs)

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