Mortality in bronchiectasis: a long-term study assessing the factors influencing survival

Loebinger, Michael R.; Wells, Adrian; Hansell, David M.; Chinyanganya, Nyasha; Devaraj, Anand; Meister, Mark G.; Wilson, Robert

doi:10.1183/09031936.00003709

Cited by 356 publications

(313 citation statements)

References 28 publications

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“…A recent study followed 91 patients with bronchiectasis enrolled in a clinical study for 13 years and found a mortality rate of 29.7% (26). Independent predictors of mortality in this cohort included age, P. aeruginosa colonization, pulmonary function, and the St. George's respiratory questionnaire, all of which support the findings of the present study (26).…”

Section: Discussionsupporting

confidence: 79%

“…Independent predictors of mortality in this cohort included age, P. aeruginosa colonization, pulmonary function, and the St. George's respiratory questionnaire, all of which support the findings of the present study (26). Onen and colleagues reported data from 98 patients with bronchiectasis in which there were 16 deaths and found age, BMI, and severity of dyspnea to be the strongest predictors of mortality (27).…”

Section: Discussionsupporting

confidence: 76%

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The Bronchiectasis Severity Index. An International Derivation and Validation Study

Chalmers

Goeminne²,

Aliberti

et al. 2014

Am J Respir Crit Care Med

843

836

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Rationale: There are no risk stratification tools for morbidity and mortality in bronchiectasis. Identifying patients at risk of exacerbations, hospital admissions, and mortality is vital for future research.Objectives: This study describes the derivation and validation of the Bronchiectasis Severity Index (BSI).Methods: Derivation of the BSI used data from a prospective cohort study (Edinburgh, UK, 2008 enrolling 608 patients. Cox proportional hazard regression was used to identify independent predictors of mortality and hospitalization over 4-year follow-up. The score was validated in independent cohorts from Dundee, UK (n = 218); Leuven, Belgium (n = 253); Monza, Italy (n = 105); and Newcastle, UK (n = 126).Measurements and Main Results: Independent predictors of future hospitalization were prior hospital admissions, Medical Research Council dyspnea score greater than or equal to 4, FEV 1 , 30% predicted, Pseudomonas aeruginosa colonization, colonization with other pathogenic organisms, and three or more lobes involved on high-resolution computed tomography. Independent predictors of mortality were older age, low FEV 1 , lower body mass index, prior hospitalization, and three or more exacerbations in the year before the study. The derived BSI predicted mortality and hospitalization: area under the receiver operator characteristic curve (AUC) 0.80 (95% confidence interval, 0.74-0.86) for mortality and AUC 0.88 (95% confidence interval, 0.84-0.91) for hospitalization, respectively.There was a clear difference in exacerbation frequency and quality of life using the St. George's Respiratory Questionnaire between patients classified as low, intermediate, and high risk by the score (P , 0.0001 for all comparisons). In the validation cohorts, the AUC for mortality ranged from 0.81 to 0.84 and for hospitalization from 0.80 to 0.88. Conclusions:The BSI is a useful clinical predictive tool that identifies patients at risk of future mortality, hospitalization, and exacerbations across healthcare systems.

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Section: Discussionsupporting

confidence: 79%

Section: Discussionsupporting

confidence: 76%

The Bronchiectasis Severity Index. An International Derivation and Validation Study

Chalmers

Goeminne²,

Aliberti

et al. 2014

Am J Respir Crit Care Med

843

836

View full text Add to dashboard Cite

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“…Various studies on patients with non-CF bronchiectasis have demonstrated the relationship of both these variables with an increase in mortality [12,13]. The high colinearity between FEV1 and forced vital capacity made it possible to choose FEV1 to represent the patient's functional state, as this is the variable most commonly used in the evaluation of airflow obstruction, the most common functional pattern in patients with bronchiectasis [24][25][26].…”

Section: Discussionmentioning

confidence: 99%

“…Several single variables have been used to predict key outcomes of bronchiectasis, such as decline in lung function, various clinical parameters, radiological extension and the presence of chronic colonisation by Pseudomonas aeruginosa [9,12,13]. However, as with other airways diseases, the severity and prognosis of bronchiectasis cannot be adequately defined with one single variable.…”

Section: Introductionmentioning

confidence: 99%

Multidimensional approach to non-cystic fibrosis bronchiectasis: the FACED score

et al. 2013

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Bronchiectasis is a multidimensional disease and, therefore, its severity or prognosis cannot be adequately quantified by analysing one single variable. The objective of the present study was to develop a multidimensional score that classifies the severity of bronchiectasis according to its prognosis. This is an observational multicentre study including 819 patients diagnosed with non-cystic fibrosis bronchiectasis using high-resolution computed tomography. 397 subjects were selected at random to construct the score while the remaining 422 were used for its validation. The outcome was 5-year all-cause mortality after radiological diagnosis. A logistic regression analysis was used to select the variables included in the final score.The final seven-point score incorporated five dichotomised variables: forced expiratory volume in 1 s % predicted (F, cut-off 50%, maximum value 2 points); age (A, cut-off 70 years, maximum value 2 points); presence of chronic colonisation by Pseudomonas aeruginosa (C, dichotomic, maximum value 1 point); radiological extension (E, number of lobes affected, cut-off two lobes, maximum value 1 point); and dyspnoea (D, cut-off grade II on the Medical Research Council scale, maximum value 1 point) to construct the FACED score. The validation cohort confirmed the score's validity.We conclude that this easy-to-use multidimensional grading system proved capable of accurately classifying the severity of bronchiectasis according to its prognosis. @ERSpublications An easy-to-use multidimensional grading system accurately classifies bronchiectasis severity according to prognosis

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“…The lower rate of colonization by this germ in this group can be one of the reasons for this finding. (16) Another fact that has been well established in the literature is that, in patients with bronchiectasis, the colonization by Staphylococcus aureus is related to a higher probability of CF diagnosis. (17) The mean age at diagnosis in CF individuals was 14 years, which was considered late diagnosis.…”

mentioning

confidence: 99%

Deve-se extrapolar o tratamento de bronquiectasias em pacientes com fibrose cística para aqueles com bronquiectasias de outras etiologias?

et al. 2010

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OBJETIVO: Conhecer o perfil de pacientes adultos com bronquiectasias, comparando portadores de fibrose cística (FC) com aqueles com bronquiectasias de outra etiologia, a fim de determinar se é racional extrapolar terapêuticas instituídas em fibrocísticos para aqueles com bronquiectasias de outras etiologias. MÉTODOS: Análise retrospectiva dos prontuários de 87 pacientes adultos com diagnóstico de bronquiectasia em acompanhamento em nosso serviço. Pacientes com doença secundária a infecção por tuberculose corrente ou no passado foram excluídos. Foram avaliados dados clínicos, funcionais e terapêuticos dos pacientes. RESULTADOS: Dos 87 pacientes com bronquiectasias, 38 (43,7%) tinham diagnóstico confirmado de FC através de dosagem de sódio e cloro no suor ou análise genética, enquanto 49 (56,3%) apresentavam a doença por outra etiologia, 34 (39,0%) desses com bronquiectasia idiopática. Os pacientes com FC apresentavam média de idade ao diagnóstico mais baixa (14,2 vs. 24,2 anos; p < 0,05). A prevalência de sintomas (tosse, expectoração, hemoptise e sibilância) foi semelhante entre os grupos. A colonização por Pseudomonas aeruginosa e a por Staphylococcus aureus foram mais comuns nos pacientes com FC (82,4 vs. 29,7% e 64,7 vs. 5,4%, respectivamente). CONCLUSÕES: As causas e as manifestações clínicas das bronquiectasias são heterogêneas, sendo importante a identificação dessas diferenças na abordagem do paciente. Reconhecer estas diferenças é crucial para o desenvolvimento de novas estratégias para o manejo de pacientes com bronquiectasias.

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Mortality in bronchiectasis: a long-term study assessing the factors influencing survival

Cited by 356 publications

References 28 publications

The Bronchiectasis Severity Index. An International Derivation and Validation Study

The Bronchiectasis Severity Index. An International Derivation and Validation Study

Multidimensional approach to non-cystic fibrosis bronchiectasis: the FACED score

Deve-se extrapolar o tratamento de bronquiectasias em pacientes com fibrose cística para aqueles com bronquiectasias de outras etiologias?

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