Association of body mass index with disease severity and prognosis in patients with non-cystic fibrosis bronchiectasis.

Q Qi,J.C Li,Y Li,T Li

doi:10.1590/1414-431x20154135

Abstract

The objective of this observational, multicenter study was to evaluate the association of body mass index (BMI) with disease severity and prognosis in patients with non-cystic fibrosis bronchiectasis. A total of 339 patients (197 females, 142 males) diagnosed with non-cystic fibrosis bronchiectasis by high-resolution computed tomography were classified into four groups: underweight (BMI<18.5 kg/m2), normal weight (18.5≤BMI<25.0 kg/m2), overweight (25.0≤BMI<30.0 kg/m2), and obese (BMI≥30.0 kg/m2). Clinical variables expressing disease severity were recorded, and acute exacerbations, hospitalizations, and survival rates were estimated during the follow-up period. The mean BMI was 21.90 kg/m2. The underweight group comprised 28.61% of all patients. BMI was negatively correlated with acute exacerbations, C-reactive protein, erythrocyte sedimentation rate, radiographic extent of bronchiectasis, and chronic colonization by P. aeruginosa and positively correlated with pulmonary function indices. BMI was a significant predictor of hospitalization risk independent of relevant covariates. The 1-, 2-, 3-, and 4-year cumulative survival rates were 94%, 86%, 81%, and 73%, respectively. Survival rates decreased with decreasing BMI (χ2=35.16, P<0.001). The arterial carbon dioxide partial pressure, inspiratory capacity, age, BMI, and predicted percentage of forced expiratory volume in 1 s independently predicted survival in the Cox proportional hazard model. In conclusion, an underweight status was highly prevalent among patients with non-cystic fibrosis bronchiectasis. Patients with a lower BMI were prone to developing more acute exacerbations, worse pulmonary function, amplified systemic inflammation, and chronic colonization by P. aeruginosa. BMI was a major determinant of hospitalization and death risks. BMI should be considered in the routine assessment of patients with non-cystic fibrosis bronchiectasis.

Highlights

Bronchiectasis is an abnormal, permanent dilatation of the bronchi and bronchioles caused by repeated cycles of airway infection and inflammation [1]
The main findings of the present study are as follows: an underweight status was highly prevalent among patients with non-cystic fibrosis (CF) bronchiectasis; body mass index (BMI) was associated with indicators reflecting disease severity, and patients with a lower BMI were prone to developing more acute exacerbations, worse pulmonary function, amplified systemic inflammation, and chronic colonization by P. aeruginosa; and BMI was a major determinant of hospitalization and death risks www.bjournal.com.br
Our study has shown that patients with non-CF bronchiectasis with a lower BMI were prone to developing worse pulmonary function

Summary

Introduction

Bronchiectasis is an abnormal, permanent dilatation of the bronchi and bronchioles caused by repeated cycles of airway infection and inflammation [1]. CF is an autosomal recessive genetic disorder that affects the lungs, and damages the pancreas, intestines, liver, sweat glands, and vas deferens. The present study only focused on patients with non-CF bronchiectasis. Non-CF bronchiectasis is associated with chronic cough and expectoration, frequent respiratory infections, lung dysfunction, and advanced dyspnea. These symptoms impose a significant burden on patients, resulting in worsening of quality of life and premature mortality [4]. Some patients with non-CF bronchiectasis exhibit weight loss and nutritional depletion. A crosssectional study of 93 patients with bronchiectasis found that 14% of patients presented with malnutrition as defined by a body mass index (BMI) of o18.5 kg/m2 [6]

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Conclusion