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Vol. 60. Issue 6.
Pages 356-363 (June 2024)
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Vol. 60. Issue 6.
Pages 356-363 (June 2024)
Original Article
Clinical Characteristics and Outcomes of the Phenotypes of COPD-Bronchiectasis Association
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Cui-xia Pana,1, Zhen-feng Hea,1, Sheng-zhu Lina,1, Jun-qing Yuea,1, Zhao-ming Chena,1, Wei-jie Guana,b,
Corresponding author
battery203@163.com

Corresponding author.
a State Key Laboratory of Respiratory Disease, National Clinical Research Center for Respiratory Disease, National Center for Respiratory Medicine, Department of Respiratory and Critical Care Medicine, Guangzhou Institute of Respiratory Health, The First Affiliated Hospital of Guangzhou Medical University, Guangzhou, Guangdong, China
b Guangzhou National Laboratory, Guangzhou, Guangdong, China
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Tables (2)
Table 1. Demographic characteristics, medication, laboratory tests, hospitalization outcomes of patients with CBA, COPD, and bronchiectasis in the training set.
Table 2. Demographic and clinical characteristics of five clusters of inpatients with CBA in the training set.
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Abstract
Introduction

Although COPD may frequently co-exist with bronchiectasis [COPD-bronchiectasis associated (CBA)], little is known regarding the clinical heterogeneity. We aimed to identify the phenotypes and compare the clinical characteristics and prognosis of CBA.

Methods

We conducted a retrospective cohort study involving 2928 bronchiectasis patients, 5158 COPD patients, and 1219 patients with CBA hospitalized between July 2017 and December 2020. We phenotyped CBA with a two-step clustering approach and validated in an independent retrospective cohort with decision-tree algorithms.

Results

Compared with patients with COPD or bronchiectasis alone, patients with CBA had significantly longer disease duration, greater lung function impairment, and increased use of intravenous antibiotics during hospitalization. We identified five clusters of CBA. Cluster 1 (N=120, CBA-MS) had predominantly moderate–severe bronchiectasis, Cluster 2 (N=108, CBA-FH) was characterized by frequent hospitalization within the previous year, Cluster 3 (N=163, CBA-BI) had bacterial infection, Cluster 4 (N=143, CBA-NB) had infrequent hospitalization but no bacterial infection, and Cluster 5 (N=113, CBA-NHB) had no hospitalization or bacterial infection in the past year. The decision-tree model predicted the cluster assignment in the validation cohort with 91.8% accuracy. CBA-MS, CBA-BI, and CBA-FH exhibited higher risks of hospital re-admission and intensive care unit admission compared with CBA-NHB during follow-up (all P<0.05). Of the five clusters, CBA-FH conferred the worst clinical prognosis.

Conclusion

Bronchiectasis severity, recent hospitalizations and sputum culture findings are three defining variables accounting for most heterogeneity of CBA, the characterization of which will help refine personalized clinical management.

Keywords:
Bronchiectasis
COPD
Clinical characteristics
Two-step clustering
Abbreviations:
COPD
CBA
CBA-MS
CBA-FH
CBA-BI
CBA-NB
CBA-NHB
FVC% pred
FEV1% pred
ICU
CCI
BSI
HRCT

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