Mortality risk and causes of death in patients with non-cystic fibrosis bronchiectasis

Abstract

BackgroundAll-cause mortality risk and causes of death in bronchiectasis patients have not been fully investigated. The aim of this study was to compare the mortality risk and causes of death between individuals with bronchiectasis and those without bronchiectasis.MethodsPatients with or without bronchiectasis determined based on chest computed tomography (CT) at one centre between 2005 and 2016 were enrolled. Among the patients without bronchiectasis, a control group was selected after applying additional exclusion criteria. We compared the mortality risk and causes of death between the bronchiectasis and control groups without lung disease. Subgroup analyses were also performed according to identification of Pseudomonas or non-tuberculous mycobacteria, airflow limitation, and smoking status.ResultsOf the total 217,702 patients who underwent chest CT, 18,134 bronchiectasis patients and 90,313 non-bronchiectasis patients were included. The all-cause mortality rate in the bronchiectasis group was 1608.8 per 100,000 person-years (95% confidence interval (CI), 1531.5–1690.0), which was higher than that in the control group (133.5 per 100,000 person-years; 95% CI, 124.1–143.8; P < 0.001). The bronchiectasis group had higher all-cause (adjusted hazard ratio (aHR), 1.26; 95% CI, 1.09–1.47), respiratory (aHR, 3.49; 95% CI, 2.21–5.51), and lung cancer-related (aHR, 3.48; 95% CI, 2.33–5.22) mortality risks than the control group. In subgroup analysis, patients with airflow limitation and ever smokers showed higher all-cause mortality risk among bronchiectasis patients. Therefore, we observed significant interrelation between bronchiectasis and smoking, concerning the risks of all-cause mortality (P for multiplicative interaction, 0.030, RERI, 0.432; 95% CI, 0.097–0.769) and lung cancer-related mortality (RERI, 8.68; 95% CI, 1.631–15.736).ConclusionIndividuals with bronchiectasis had a higher risk of all-cause, respiratory, and lung cancer-related mortality compared to control group. The risk of all-cause mortality was more prominent in those with airflow limitation and in ever smokers.

Increased mortality in patients with non cystic fibrosis bronchiectasis with respiratory comorbidities

“…This finding suggests that bronchiectasis-related comorbidities, including asthma, COPD, pneumonia, lung cancer, and cardiovascular diseases, may play a major role in increased mortality in the bronchiectasis cohort relative to the matched cohort. As shown in the previous reports 18 , 21 – 24 , respiratory conditions were common causes of mortality among patients with bronchiectasis in the present study. Comorbid COPD and asthma (both of which are included in the Bronchiectasis Aetiology Comorbidity Index [BACI]) are significantly associated with higher mortality in patients with bronchiectasis 21 , 23 , 28 – 31 .…”

“…Consistent with other authors, we found high mortality in patients with bronchiectasis 12 , 18 – 23 . However, in previous studies, the sample sizes were relatively small 18 – 22 , the mortality rate was not compared with that of controls 12 , 18 – 23 , or patients were only enrolled at a single centre 20 – 22 , 24 . Thus, data from previous studies were not generalisable.…”

“…Because the risk of coronary heart disease and stroke is higher in patients with bronchiectasis than in the general population 33 , 34 , such comorbidities require close attention in patients with bronchiectasis. Although we excluded patients diagnosed with malignancies at the time of enrolment, malignancy (especially lung cancer) was an important cause of mortality in patients with bronchiectasis, as shown in a previous study 24 . When we consider that many bronchiectasis patients had COPD 35 , a well-known risk factor for lung cancer 36 , we suspect that bronchiectasis may increase the risk of lung cancer 37 .…”

Prevalence and clinical implications of bronchiectasis in patients with overlapping asthma and chronic rhinosinusitis: a single-center prospective study

“…Several previous studies have described the adverse effects of smoking on asthma and CRS [ 37 , 38 ], and similarly, smoking was an independent risk factor for the severity and prognosis of bronchiectasis [ 39 ]. Our study also demonstrated that there was a positive correlation between the severity of bronchiectasis and positive smoking status.…”

Impact of non-cystic fibrosis bronchiectasis on critically ill patients in Korea: a retrospective observational study

“…Fourth, the impact of bronchiectasis on the specific cause of death could not be evaluated. Sin et al 31 reported that the increased risk of all-cause mortality in bronchiectasis patients was related to respiratory disease and lung cancer when compared with the control population in Korea. However, as ICU-admitted patients usually have multiple organ damage, it is hard to define the specific reason for mortality.…”