International Journal of COPD (Sep 2020)
Performance of Multidimensional Severity Scoring Systems in Patients with Post‐Tuberculosis Bronchiectasis
Abstract
Abdullah AL-Harbi,1– 3 Majed AL-Ghamdi,1– 3 Mohammad Khan,1– 3 Sulaiman AL-Rajhi,1,3,4 Hamdan AL-Jahdali1– 3 1College of Medicine, King Saud University for Health Sciences, Riyadh, Saudi Arabia; 2Department of Medicine, Pulmonary Division, Ministry of National Guard-Health Affairs, Riyadh, Saudi Arabia; 3King Abdullah International Medical Research Center, Riyadh, Saudi Arabia; 4Department of Medical Imaging, Ministry of National Guard-Health Affairs, Riyadh, Saudi ArabiaCorrespondence: Abdullah AL-HarbiDepartment of Medicine, Pulmonary Division, Ministry of National Guard-Health Affairs, King Abdulaziz Medical City, PO Box 22490, MC 1443, Riyadh 11426, Saudi ArabiaEmail [email protected]: The aim of this study was to assess the clinical characteristics and outcomes of patients with post‐tuberculosis (post-TB) bronchiectasis. We also evaluated the performance of various multidimensional severity score systems to predict mortality, future exacerbation, and hospitalization.Methods: We conducted a prospective observational cohort study to evaluate the etiology of bronchiectasis in 301 patients. Patients fell into three groups: post-TB (129 [43%]), idiopathic (76 [25%]), and other (96 [32%]) etiologies of bronchiectasis. Four multidimensional grading scales, including the Bronchiectasis Severity Index (BSI), the FACED score, and two derivative versions of the FACED score, Exacerbation (Exa-FACED and E-FACED), were calculated and compared for each patient.Results: Patients with post-TB bronchiectasis were predominantly female (61%) with a mean age of 68± 11 years. Moreover, 26% of post-TB bronchiectasis patients were colonized with Pseudomonas aeruginosa. At baseline, patients with post-TB bronchiectasis were older, had higher severity scores, and were more likely to have experienced severe exacerbations that required hospitalization compared to patients with idiopathic bronchiectasis or bronchiectasis arising from other causes. During follow-up, 52% of patients required hospitalization, 58% had frequent (≥ 2 per year) acute exacerbations, and the overall 5-year mortality rate was 30%. Five-year survival was efficiently predicted by each of the grading scales. Although the modified variations of the FACED outperformed the original FACED scale in predicting forthcoming frequent acute exacerbations and hospitalization, the BSI outperformed all three systems in this regard.Conclusion: Patients with post-TB bronchiectasis had higher severity scores than patients with idiopathic bronchiectasis or bronchiectasis arising from other causes. In addition, all scoring systems performed adequately in 5-year mortality projections. BSI and the modified versions of the FACED outperformed the FACED in predicting forthcoming exacerbations and hospitalizations.Keywords: bronchiectasis, post-TB bronchiectasis, Bronchiectasis Severity Index, BSI, FACED score, acute exacerbation, hospitalization, Exacerbation-FACED score, Exa-FACED score, E-FACED score
