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

What is it about?

Bronchiectasis is complex and heterogeneous disease, whose severity or prognosis cannot be defined using a single variable. Therefore, the multidimensional FACED and E-FACED scores have recently been developed and validated as useful tools to better evaluate the disease's severity and prognosis. They have been shown to predict all-cause and respiratory mortality in large cohorts of patients with bronchiectasis from different countries, both at five-year and after long-term follow-up. However, short-term mortality risk from has not been yet analysed in these scores. Thus, we conducted a study to investigate the ability of the FACED and E-FACED scores to predict annual mortality in patients with bronchiectasis from the first to the fifth year of follow-up, beginning at the radiological diagnosis. This study included 1,470 consecutive patients: 819 from Spain and 651 from three different countries in Latin America (Argentina, Brazil and Chile). The mean age of the included patients was 54.1 ± 17.7 years, and 61% of them were women. According to the FACED and E-FACED scores, 56.6% and 61.5% presented mild bronchiectasis; 29.5% and 30% moderate bronchiectasis and 13.8% and 8.6% severe bronchiectasis, respectively. The cumulative mortality was as follows: first year: 37 patients (2.5%); second year: 72 patients (4.9%); third year: 129 patients (8.8%); fourth year 184 patients (12.5%); and fifth year 249 patients (16.9%). The graphical representation using ROC curves showed that for each year of follow-up, both scores maintained an excellent predictive power for all-cause mortality in the short-term: the annual AUC ROC for FACED ranged from 0.77-0.83 and for E-FACED from 0.79-0.84. The range value of AUC-ROC for BSI was very similar to the range value for FACED and E-FACED. This prognostic ability could improve bronchiectasis management in both daily practice and clinical trial scenarios. As for daily practice, this short-term prognosis may help to identify patients who need more intensive or preventive treatments, such as chronic antibiotics or anti-inflammatory agents, and to develop personalized management strategies that allow an individualized approach. As regards the clinical trials scenario, these scores may play an important role in identifying a more precise population that could benefit from specific interventions based on a shorter or longer expected mechanism of action.

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