Latin America validation of FACED score in patients with bronchiectasis: an analysis of six cohorts

Abstract

BackgroundThe FACED score is an easy-to-use multidimensional grading system that has demonstrated an excellent prognostic value for mortality in patients with bronchiectasis. A Spanish group developed the score but no multicenter international validation has yet been published.MethodsRetrospective and multicenter study conducted in six historical cohorts of patients from Latin America including 651 patients with bronchiectasis. Clinical, microbiological, functional, and radiological variables were collected, following the same criteria used in the original FACED score study. The vital status of all patients was determined in the fifth year of follow-up. The area under ROC curve (AUC-ROC) was used to calculate the predictive power of the FACED score for all-cause and respiratory deaths and both number and severity of exacerbations. The discriminatory power to divide patients into three groups of increasing severity was also analyzed.ResultsMean (SD) age of 48.2 (16), 32.9% of males. The mean FACED score was 2.35 (1.68). During the follow up, 95 patients (14.6%) died (66% from respiratory causes). The AUC ROC to predict all-cause and respiratory mortality were 0.81 (95% CI: 0.77 to 0.85) 0.84 (95% CI: 0.80 to 0.88) respectively, and 0.82 (95% CI: 078–0.87) for at least one hospitalization per year. The division into three score groups separated bronchiectasis into distinct mortality groups (mild: 3.7%; moderate: 20.7% and severe: 48.5% mortality; p < 0.001).ConclusionsThe FACED score was confirmed as an excellent predictor of all-cause and respiratory mortality and severe exacerbations, as well as having excellent discriminative capacity for different degrees of severity in various bronchiectasis populations.Electronic supplementary materialThe online version of this article (doi:10.1186/s12890-017-0417-3) contains supplementary material, which is available to authorized users.

The annual prognostic ability of FACED and E-FACED scores to predict mortality in patients with bronchiectasis

“…The FACED and E-FACED scores have been shown to predict all-cause and respiratory mortality in large cohorts of patients with bronchiectasis from different countries, both at 5 years [ 5 – 7 ] and after long-term follow-up [ 9 ]. However, while the BSI score has demonstrated good predictive value for mortality risk from the first to the fourth year from the radiological diagnosis of bronchiectasis [ 8 ], this parameter has not been yet analysed in FACED and E-FACED scores.…”

“…Data were analysed from an international, observational and multicentre study of historical cohorts in adult patients with bronchiectasis from Spain and Latin America. These data were originally used to create and validate the FACED and E-FACED scores published elsewhere [ 5 – 7 ]. The diagnosis of bronchiectasis was made using high-resolution computed tomography in all patients.…”

“…Patients with cystic fibrosis were excluded from the study. All centres used the same protocol to collect patients' information as previously published [ 5 – 7 ]. The variables studied were: age, sex, body mass index, dyspnoea (modified Medical Research Council score), presence of chronic respiratory failure, exacerbations and hospitalisations in the previous year, radiological findings, bronchiectasis aetiology, microbiological profile, respiratory function test and usual treatments.…”

Pseudomonas aeruginosainfection and exacerbations in bronchiectasis: more questions than answers

“…Maybe additional data for specific geographical areas could be taken from national guidelines on bronchiectasis ( probably this is why national guidelines are also important) where the recommended general treatment of international guidelines could be sometimes modified according to particular local circumstances [24]. The study by ARAÚJO et al [15] for example, shows how the prevalence of CBI by P. aeruginosa varies enormously from one country to another, ranging from 0.9% in Serbia and 12.5% in the UK to over 21% in Spain and around 40% in Greece and Israel; and the latter percentage may possibly be matched, or even surpassed, in Latin American countries [25] and China [26]. It may therefore be appropriate to start treatment with inhaled antibiotics in patients with marked clinical deterioration as a result of CBI by P. aeruginosa; or in those with several comorbidities ( particularly in countries with an ageing population that is therefore subject to a higher probability of concomitant diseases); or in microbiological environments with a high prevalence of CBI by P. aeruginosa or a high level of resistance to treatment, to avoid any deterioration in the microbiological situation (many of the multi-resistant P. aeruginosa maintain a good sensitivity to colistin, a drug available via the inhaled route [27]).…”

Infección crónica por Pseudomonas aeruginosa en pacientes con bronquiectasias no fibrosis quística

“…Se reconoce como una enfermedad frecuente, con una prevalencia variable según la población estudiada, que varía de 53 a 566 casos por 100.000 habitantes con predominio en el género femenino 2 . corresponden a un grupo heterogéneo, con diversas etiologías y distintos grados de severidad, que han motivado la investigación clínica y la creación de guías de manejo durante los últimos años, principalmente en europa 1 , con importantes iniciativas latinoamericanas [5][6][7] , pero aún con muchas interrogantes por resolver, con un creciente desarrollo de la investigación de esta patología.…”