Abstract
Bronchiectasis is characterized by systemic inflammation and multiple comorbidities. This study aimed to investigate the clinical outcomes based on the bronchiectasis etiology comorbidity index (BACI) score in patients hospitalized for severe bronchiectasis exacerbations. We included non-cystic fibrosis patients hospitalized for severe bronchiectasis exacerbations between January 2008 and December 2016 from the Chang Gung Research Database (CGRD) cohort. The main outcome was the 1-year mortality rate after severe exacerbations. We used the Cox regression model to assess the risk factors of 1-year mortality. Of 1,235 patients who were hospitalized for severe bronchiectasis exacerbations, 641 were in the BACI < 6 group and 594 in the BACI ≥ 6 group. The BACI ≥ 6 group had more previous exacerbations and a lower FEV1. Pseudomonas aeruginosa (19.1%) was the most common bacterium, followed by Klebsiella pneumoniae (7.5%). Overall, 11.8% of patients had respiratory failure and the hospital mortality was 3.0%. After discharge, compared to the BACI < 6 group, the BACI ≥ 6 group had a significantly higher cumulative incidence of respiratory failure and mortality in a 1-year follow-up. The risk factors for 1-year mortality in a multivariate analysis include age [hazard ratio (HR) 4.38, p = 0.01], being male (HR 4.38, p = 0.01), and systemic corticosteroid usage (HR 6.35, p = 0.001), while airway clearance therapy (ACT) (HR 0.50, p = 0.010) was associated with a lower mortality risk. An increased risk of respiratory failure and mortality in a 1-year follow-up after severe exacerbations was observed in bronchiectasis patients with multimorbidities, particularly older age patients, male patients, and patients with a history of systemic corticosteroid use. ACT could effectively improve the risk for 1-year mortality.
Highlights
Bronchiectasis is characterized by permanent dilatation of the bronchi and airway inflammation [1], leading to the excess mucus secretion that can make the lungs more vulnerable to infection
Our results further indicate that airway clearance therapy (ACT) can reduce the risk of respiratory failure and mortality during a 1-year follow-up in patients with bronchiectasis hospitalized for pneumonia
Several indexes such as Bronchiectasis Severity Index (BSI), FACED, E-FACED, and bronchiectasis etiology comorbidity index (BACI) have been developed, and their scores have been used as the predictors of mortality in bronchiectasis [1, 2, 5, 32]
Summary
Bronchiectasis is characterized by permanent dilatation of the bronchi and airway inflammation [1], leading to the excess mucus secretion that can make the lungs more vulnerable to infection. The potential risk factors such as hospital admissions and quality of life score have been utilized to predict the risk of death in patients with bronchiectasis [1, 2, 5,6,7]. The bronchiectasis etiology comorbidity index (BACI) scoring system based on 13 comorbidities has been developed and validated to stratify the risk of mortality and hospital admissions in an European cohort [1]. We recently used the BACI to assess the severity of bronchiectasis from different etiologies [13], but have not yet analyzed the clinical treatment outcome and mortality of patients with bronchiectasis hospitalized for pneumonia based on BACI scores to stratify their severity
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