1 Tayside Respiratory Research Group, University of Dundee, Dundee, United Kingdom.
Am J Respir Crit Care Med. 2014 Mar 1;189(5):576-85. doi: 10.1164/rccm.201309-1575OC.
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.
This study describes the derivation and validation of the Bronchiectasis Severity Index (BSI).
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).
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.
The BSI is a useful clinical predictive tool that identifies patients at risk of future mortality, hospitalization, and exacerbations across healthcare systems.
目前尚无支气管扩张症发病率和死亡率的风险分层工具。确定易发生加重、住院和死亡的患者对未来的研究至关重要。
本研究描述了支气管扩张症严重程度指数（BSI）的推导和验证。
使用前瞻性队列研究（英国爱丁堡，2008-2012 年）的数据来推导 BSI，该研究纳入了 608 例患者。使用 Cox 比例风险回归来确定 4 年随访期间死亡率和住院的独立预测因素。该评分在来自英国邓迪（n=218）、比利时鲁汶（n=253）、意大利蒙扎（n=105）和英国纽卡斯尔（n=126）的独立队列中进行了验证。
未来住院的独立预测因素包括既往住院、英国医学研究理事会呼吸困难评分≥4 分、FEV1<30%预计值、铜绿假单胞菌定植、其他病原体定植和高分辨率计算机断层扫描上三个或更多肺叶受累。死亡的独立预测因素包括年龄较大、FEV1 较低、身体质量指数较低、既往住院和研究前一年内发生 3 次或更多次加重。推导的 BSI 预测死亡率和住院率：死亡的受试者工作特征曲线（ROC）曲线下面积（AUC）为 0.80（95%置信区间，0.74-0.86），住院的 AUC 为 0.88（95%置信区间，0.84-0.91）。根据评分分类为低、中、高危的患者之间，在加重频率和圣乔治呼吸问卷的生活质量方面有明显差异（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，住院的 AUC 范围为 0.80 至 0.88。
BSI 是一种有用的临床预测工具，可识别不同医疗体系中未来死亡、住院和加重风险的患者。
