Yan Marie, Fraser Brooke, McArthur Eric, Mehrabi Matty, Brode Sarah K, Marras Theodore K
Department of Medicine, University of Toronto, Canada; Department of Medicine, University of British Columbia, Vancouver, BC, Canada.
Department of Medicine, University of Toronto, Canada.
Chest. 2024 Mar;165(3):521-528. doi: 10.1016/j.chest.2023.10.006. Epub 2023 Oct 10.
The clinical course of nontuberculous mycobacterial pulmonary disease (NTM-PD) can be variable and difficult to predict. Recently, the BACES score was developed as a tool to predict all-cause mortality in patients with NTM-PD. This score is calculated based on five patient characteristics (BMI, age, cavity, erythrocyte sedimentation rate, and sex), and higher scores portend worse prognosis. Although the BACES score has been validated in a cohort of South Korean patients, it has not yet been validated in other settings or ethnic groups.
How well does the BACES mortality score perform in a cohort of Canadian patients with NTM-PD?
We performed a single-center retrospective chart review. Patients who were seen between July 2003 and June 2021 were eligible for inclusion if they met guideline-based diagnostic criteria for NTM-PD and were excluded if any component of the BACES score was missing. To assess the model's discriminatory performance, we compared Kaplan-Meier curves between risk groups and calculated Harrell's C index. To assess calibration, we used a graphical calibration curve.
The cohort included 435 patients with a median follow-up of 5.8 years. The median age was 64 years and 74% were female. Based on the BACES scores, patients were classified into three risk groups: low, moderate, or high. Survival curves showed clear separation of the risk groups. Harrell's C index was 0.733 in the study cohort, indicating moderate to good discriminatory performance, although this was lower than the value reported in the derivation cohort (0.812). The graphical calibration curve showed a tendency of the BACES model to underpredict mortality.
The BACES model was evaluated in a multicultural cohort of Canadian patients and demonstrated good discriminatory performance but suboptimal calibration, which may be due to population differences, the use of dichotomized variables in model construction, or both.
非结核分枝杆菌肺病（NTM-PD）的临床病程可能多变且难以预测。最近，BACES评分被开发出来作为预测NTM-PD患者全因死亡率的工具。该评分基于五个患者特征（体重指数、年龄、空洞、红细胞沉降率和性别）计算得出，分数越高预后越差。尽管BACES评分已在一组韩国患者中得到验证，但尚未在其他环境或种族群体中得到验证。
BACES死亡率评分在一组加拿大NTM-PD患者中的表现如何？
我们进行了一项单中心回顾性病历审查。2003年7月至2021年6月期间就诊的患者，如果符合基于指南的NTM-PD诊断标准则 eligible for inclusion，如果BACES评分的任何一项缺失则被排除。为了评估该模型的区分性能，我们比较了风险组之间的Kaplan-Meier曲线并计算了Harrell's C指数。为了评估校准情况，我们使用了图形校准曲线。
该队列包括435名患者，中位随访时间为5.8年。中位年龄为64岁，74%为女性。根据BACES评分，患者被分为三个风险组：低、中或高。生存曲线显示风险组之间有明显区分。研究队列中的Harrell's C指数为0.733，表明区分性能为中等至良好，尽管低于推导队列中报告的值（0.812）。图形校准曲线显示BACES模型有低估死亡率的趋势。
BACES模型在一组加拿大多元文化患者队列中进行了评估，显示出良好的区分性能，但校准效果欠佳，这可能是由于人群差异、模型构建中使用二分变量或两者兼而有之。
