Predicting high risk of exacerbations in bronchiectasis: the E-FACED score

Abstract

BackgroundAlthough the FACED score has demonstrated a great prognostic capacity in bronchiectasis, it does not include the number or severity of exacerbations as a separate variable, which is important in the natural history of these patients.ObjectiveConstruction and external validation of a new index, the E-FACED, to evaluate the predictive capacity of exacerbations and mortality.MethodsThe new score was constructed on the basis of the complete cohort for the construction of the original FACED score, while the external validation was undertaken with six cohorts from three countries (Brazil, Argentina, and Chile). The main outcome was the number of annual exacerbations/hospitalizations, with all-cause and respiratory-related deaths as the secondary outcomes. A statistical evaluation comprised the relative weight and ideal cut-off point for the number or severity of the exacerbations and was incorporated into the FACED score (E-FACED). The results obtained after the application of FACED and E-FACED were compared in both the cohorts.ResultsA total of 1,470 patients with bronchiectasis (819 from the construction cohorts and 651 from the external validation cohorts) were followed up for 5 years after diagnosis. The best cut-off point was at least two exacerbations in the previous year (two additional points), meaning that the E-FACED has nine points of growing severity. E-FACED presented an excellent prognostic capacity for exacerbations (areas under the receiver operating characteristic curve: 0.82 for at least two exacerbations in 1 year and 0.87 for at least one hospitalization in 1 year) that was statistically better than that of the FACED score (0.72 and 0.78, P<0.05, respectively). The predictive capacities for all-cause and respiratory mortality were 0.87 and 0.86, respectively, with both being similar to those of the FACED.ConclusionE-FACED score significantly increases the FACED capacity to predict future yearly exacerbations while maintaining the score’s simplicity and prognostic capacity for death.

Aetiology and disease severity are among the determinants of quality of life in bronchiectasis

“…Hereby, more patients are classified as “severe” disease using the BSI as compared to the FACED, and suggests that these scores measures different things; BSI is a severity assessment tool and FACED accurately predicts risk of death . Recently, Martinez‐Garcia published the E‐FACED, and incorporated the number of severe exacerbations in 1 year into the FACED. The E‐FACED showed a greater prognostic capacity for exacerbations and hospitalizations and its capacity to discriminate degrees of severity.…”

“…The disease severity was calculated using the validated BSI‐score and FACED score . In addition, the recently published E‐FACED score was also used to assess the disease severity . The BSI scoring system identifies individuals at risk of mortality, hospital admissions, and exacerbations, while the FACED score predicts the probability of all‐cause mortality after 5 years of follow up .…”

British Thoracic Society Guideline for bronchiectasis in adults

“…Prior exacerbations are also the strongest predictor of future exacerbations which explains why a number of studies have found FACED to be poorly predictive of future morbidity. 121–123 For this reason the BSI is the preferred scoring system. At the time of writing, modifications of the FACED score to include exacerbations are undergoing evaluation.…”

Cost of Hospitalizations due to Exacerbation in Patients with Non-Cystic Fibrosis Bronchiectasis

“…The following data were collected: demographic data, clinical data (age at start of symptoms and diagnosis of BE, presence and habitual type of expectoration, scale of mMRC dyspnea, exacerbade la Rosa Carrillo et al tions and admissions during the previous year, Charlson Comorbidity Index); BE etiology; etiological tests performed; radiological extension of BE; microbiological data; spirometric data; severity of BE according to Bronchiectasis Severity Index (BSI), FACED, and E-FACED scores [8,15,16]; time spent in the emergency department, in the hospital ward, and in the HH. We also collected data on employment, salary, the need for sick leave of the patient during the exacerbation, and the need for sick leave of the caregiver.…”