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

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Date

2017-01-18

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

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Abstract

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, P E-FACED score significantly increases the FACED capacity to predict future yearly exacerbations while maintaining the score's simplicity and prognostic capacity for death.

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Adult
Age Factors
Aged
Area Under Curve
Argentina
Brazil
Bronchiectasis
Cause of Death
Chile
Disease Progression
Dyspnea
Female
Forced Expiratory Volume
Health Status
Health Status Indicators
Hospitalization
Humans
Lung
Male
Middle Aged
Predictive Value of Tests
Pseudomonas Infections
Pseudomonas aeruginosa
ROC Curve
Reproducibility of Results
Respiratory Tract Infections
Risk Factors
Severity of Illness Index
Time Factors

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Keywords

E-FACED score, FACED score, bronchiectasis, exacerbations, mortality

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