The Bronchiectasis Severity Index An International Derivation and Validation Study
The Bronchiectasis Severity Index An International Derivation and Validation Study
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DOI：
10.1164/rccm.201309-1575oc
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发表时间：
2014-03-01
影响因子：
24.7
通讯作者：
Hill, Adam T.
中科院分区：
文献类型：
--
作者：
Chalmers, James D.;Goeminne, Pieter;Hill, Adam T.
理由：对于支气管扩张的发病率和死亡率没有风险分层工具。识别有病情恶化、住院和死亡风险的患者对未来的研究至关重要。目的：本研究描述了支气管扩张严重程度指数（BSI）的推导和验证。方法：BSI的推导使用的数据来自一项前瞻性队列研究（爱丁堡，英国，2008-2012），共纳入608名患者。采用Cox比例风险回归确定4年随访期间死亡率和住院率的独立预测因素。该评分在英国邓迪的独立队列中得到验证（n = 218）；比利时鲁汶（253人）；意大利蒙扎（n = 105）；英国纽卡斯尔（n = 126）。测量结果和主要结果：未来住院的独立预测因素为先前住院，医学研究委员会呼吸困难评分大于或等于4，预测FEV1 < 30%，铜绿假单胞菌定植，与其他致病生物定植，高分辨率计算机断层扫描累及三个或更多肺叶。死亡率的独立预测因子为年龄较大、低FEV1、较低的体重指数、既往住院以及研究前一年三次或三次以上的恶化。导出的BSI预测死亡率和住院率：死亡率和住院率分别为：接收者操作符特征曲线下面积（AUC） 0.80（95%可信区间，0.74-0.86）和AUC 0.88（95%可信区间，0.84-0.91）。使用圣乔治呼吸问卷评分将患者分为低、中、高风险，在急性发作频率和生活质量方面存在明显差异（所有比较P < 0.0001）。在验证队列中，死亡率的AUC范围为0.81至0.84，住院率的AUC范围为0.80至0.88。结论：BSI是一种有用的临床预测工具，可识别医疗保健系统中存在未来死亡、住院和恶化风险的患者。
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.