Defining severity of disease and prognosis
In contrast with other respiratory diseases like COPD, pulmonary fibrosis and pneumonia, which have well established disease severity scores, assessment of disease severity is a relatively new concept in bronchiectasis. A combination of clinical, radiological and microbiological features can be used to assess severity, and members of EMBARC recently described a scoring system which has been validated in 1310 patients across 5 European bronchiectasis centres. The bronchiectasis severity index was found to give excellent predictions of mortality and hospital admissions and was also predictive of exacerbations and quality of life, giving a broad assessment of disease severity.
| Criteria | 0 Points | 1 Point | 2 Points | 3 Points | 4 Points | 5 Points | 6 Points |
|---|---|---|---|---|---|---|---|
| Age | <50 | – | 50-69 | – | 70-79 | – | 80+ |
| BMI kg/m² | >=18.5 | – | <18.5 | – | – | – | |
| FEV1 % Predicted | >80% | 50-80% | 30-49% | <30% | – | – | – |
| Hospital Admissions in the Past 2 Years | No | – | – | – | – | Yes | – |
| Exacerbation Frequency in Last 12 Months | 0-2 | – | 3 or more | – | – | – | – |
| MRC Dyspnoea Score | 1-3 | – | 4 | 5 | – | – | – |
| Colonisation Status | Not colonised | Chronic colonisation | – | P. aeruginosa colonisation | – | – | – |
| Radiological Severity | <3 lobes involved | 3 or more lobes or cystic changes | – | – | – | – | – |
| Score Range | 1-Year Mortality Rate | 1-Year Hospitalisation Rate | 4-Year Mortality Rate | 4-Year Hospitalisation Rate |
|---|---|---|---|---|
| 0-4 Points | 0-2.8% | 0-3.4% | 0-5.3% | 0-9.2% |
| 5-8 Points | 0.9-4.8% | 1-7.2% | 4-11.3% | 9.9-19.4% |
| 9+ Points | 7.6-10.5% | 16.7-52.6% | 9.9-29.2% | 41.2-80.4% |