Abstract
BackgroundBronchiectasis is a chronic lung condition frequently associated with nontuberculous mycobacteria pulmonary (NTM) disease. Persons with these conditions are at increased risk of mortality. Patient reported outcome (PRO) instruments and the 6-minute walk test (6MWT) have been shown to predict mortality for several lung conditions, but these measures have not been fully evaluated for bronchiectasis and NTM.MethodsWe conducted a retrospective cohort study among adult patients enrolled in a natural history study of bronchiectasis at the National Heart, Lung, and Blood Institute. Electronic medical records were queried for demographic, clinical, microbiologic, radiographic, and PRO instrument data: St. George’s Respiratory Questionnaire (SGRQ), Medical Research Council Dyspnea Scale, and the Pulmonary Symptom Severity Score (PSSS). The study baseline date was defined as the patient’s first visit after January 1st, 2015 with a SGRQ or 6MWT completed. Follow-up was defined as the interval between the study baseline visit and date of death or December 31st, 2019. Sex-stratified Cox proportional-hazards regression was conducted to identify predictors of mortality. Separate models were run for each PRO and 6MWT measure, controlling for age, body mass index (BMI), fibrocavitary disease status, and M. abscessus infection.ResultsIn multivariable Cox proportional-hazards regression models, the PSSS-severity (aHR 1.29, 95% CI 1.04–1.59), the 6MWT total distance walked (aHR 0.938, 95% CI 0.896–0.981) and distance saturation product (aHR 0.930, 95% CI 0.887–0.974) independently predicted mortality. In addition, BMI was significantly predictive of mortality in all models.ConclusionsThe 6MWT and a PRO instrument capturing symptom severity are independently predictive of mortality in our cohort of bronchiectasis patients.
Highlights
Bronchiectasis is a chronic lung condition frequently associated with nontuberculous mycobacteria pulmonary (NTM) disease
Persons with bronchiectasis are at very high risk of chronic infection with nontuberculous mycobacteria (NTM) [2], which is associated with an increased risk of mortality even after controlling for comorbidities [3,4,5]
Several studies found low body mass index (BMI) to be a risk factor for increased mortality [6]. Functional measures such as the 6-Minute Walk Test (6MWT) have been less frequently measured systematically for studies of NTM and bronchiectasis disease progression. These measures have been identified as important mortality predictors for chronic obstructive pulmonary disease (COPD) [7] as well as for idiopathic pulmonary fibrosis [8]
Summary
Bronchiectasis is a chronic lung condition frequently associated with nontuberculous mycobacteria pulmonary (NTM) disease Persons with these conditions are at increased risk of mortality. Several studies found low body mass index (BMI) to be a risk factor for increased mortality [6] Functional measures such as the 6-Minute Walk Test (6MWT) have been less frequently measured systematically for studies of NTM and bronchiectasis disease progression. These measures have been identified as important mortality predictors for chronic obstructive pulmonary disease (COPD) [7] as well as for idiopathic pulmonary fibrosis [8]. The 6MWT correlates with quality-of-life measurements in patients with bronchiectasis and MAC lung disease [9, 10]
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