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

• Published in: International journal of chronic obstructive pulmonary disease Vol. 12; pp. 275 - 284
• Main Authors: Martinez-Garcia, M A, Athanazio, R A, Girón, R, Máiz-Carro, L, de la Rosa, D, Olveira, C, de Gracia, J, Vendrell, M, Prados-Sánchez, C, Gramblicka, G, Corso Pereira, M, Lundgren, F L, Fernandes De Figueiredo, M, Arancibia, F, Rached, S Z
• Format: Journal Article
• Language: English
• Published: New Zealand Dove Medical Press Limited 01-01-2017; Dove Medical Press Ltd; Dove Medical Press
• Subjects: Adult; Age Factors; Aged; Antibiotics; Area Under Curve; Argentina; Brazil; Bronchiectasis; Bronchiectasis - diagnosis; Bronchiectasis - mortality; Bronchiectasis - physiopathology; Bronchiectasis - therapy; Cause of Death; Chile; Construction; Disease Progression; Dyspnea - physiopathology; E-FACED score; Evaluation; exacerbations; FACED score; Female; Forced Expiratory Volume; Health Status; Health Status Indicators; Hospitalization; Humans; Lung - microbiology; Lung - physiopathology; Male; Medical diagnosis; Medical research; Middle Aged; Mortality; Original Research; Predictive Value of Tests; Pseudomonas aeruginosa - isolation & purification; Pseudomonas Infections - diagnosis; Pseudomonas Infections - microbiology; Reproducibility of Results; Respiratory Tract Infections - diagnosis; Respiratory Tract Infections - microbiology; Risk Factors; ROC Curve; Severity of Illness Index; Time Factors; Variables; E-FACED score; mortality; bronchiectasis; exacerbations; FACED score
• ISSN: 1178-2005; 1176-9106; 1178-2005
• DOI: 10.2147/COPD.S121943

Although 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.
Construction and external validation of a new index, the E-FACED, to evaluate the predictive capacity of exacerbations and mortality.
The 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.
A 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,
<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.
E-FACED score significantly increases the FACED capacity to predict future yearly exacerbations while maintaining the score's simplicity and prognostic capacity for death.