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Vol. 55. Issue 2.
Pages 81-87 (February 2019)
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Vol. 55. Issue 2.
Pages 81-87 (February 2019)
Original
Prognostic Value of Frequent Exacerbations in Bronchiectasis: The Relationship With Disease Severity
Valor pronóstico de las exacerbaciones en las bronquiectasias: relación con la gravedad de la enfermedad
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Miguel Ángel Martinez-Garciaa,
Corresponding author
mianmartinezgarcia@gmail.com

Corresponding author.
, Rodrigo Athanaziob, Giorgina Gramblickac, Mónica Corsod, Fernando Cavalcanti Lundgrene, Mara Fernandes de Figueiredof, Francisco Arancibiag, Samia Rachedb, Rosa Girónh, Luis Máiz Carroi, David de la Rosa Carrilloj, Concepción Pradosk, Casilda Olveiral
a Pulmonary Service, Polytechnic and University La Fe Hospital, Valencia, Spain
b Pulmonary Division, Heart Institute (InCor) Hospital das Clinicas da Faculdade de São Paulo, São Paulo, SP, Brazil
c Pneumology Service Hospital del Tórax, Dr A. Centrángolo, Buenos Aires, Argentina
d Pneumology Service, Universidade Estadual de Campinas UNICAMP, São Paulo, SP, Brazil
e Pneumology Service, Hospital Octávio de Freitas, Recife, PE, Brazil
f Pneumology Service, Hospital de Messejana, Fortaleza, CE, Brazil
g Pneumology Service, Instituto Nacional del Tórax, Santiago de Chile, Chile
h Pneumology Service, Hosp. La Princesa, Madrid, Spain
i Pneumology Service, Hosp. Ramón y Cajal, Madrid, Spain
j Pneumology Unit, Hospital Platón, Barcelona, Spain
k Pneumology Service, Hosp. La Paz-IS Carlos III, Madrid, Spain
l Pneumology Service, Instituto de Investigación Biomédica de Málaga (IBIMA), Hospital Regional Universitario de Málaga/Universidad de Málaga, Spain
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Tables (5)
Table 1. Baseline Characteristics of the Included Patients (n=651).
Table 2. Prognostic Value of 5-year All-cause Mortality (AUC-ROC) of 12 Different Potential Definitions of “Frequent Exacerbator Patient” in Bronchiectasis.
Table 3. Comparison of the Characteristics of Patients Who Satisfied the Definition of the Chosen Frequent Exacerbator Patient and Those of the Other Patients With Bronchiectasis.
Table 4. Cox Regressions Using Different Combinations of Multidimensional Severity Scores as Independent Variables to Evaluate the Initial Severity of Bronchiectasis, and the Selected Definition of Frequent Exacerbator Patient.
Table 5. Distribution of Patients With Frequent Exacerbation, Using the Selected Definition, and Associated Mortality According to the Severity (Mild, Moderate or Severe) Evaluated by the BSI, FACED, and E-FACED Scores.
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Abstract
Introduction

Bronchiectasis is a very heterogeneous disease but some homogeneous groups with similar clinical characteristics and prognosis have been identified. Exacerbations have been shown to have a negative impact on the natural history of bronchiectasis. The objective of this study was to identify the definition and characteristics of the “frequent exacerbator patient” with the best prognostic value and its relationship with the severity of bronchiectasis.

Methods

A historical cohort of 651 patients diagnosed with bronchiectasis was included. They had all received 5 years of follow-up since their radiological diagnosis. Exacerbation was defined as a worsening of the symptoms derived from bronchiectasis that required antibiotic treatment. The main outcome was all-cause mortality at the end of follow-up.

Results

The mean age was 48.2 (16) years (32.9% males). 39.8% had chronic infection by Pseudomonas aeruginosa. Mean BSI, FACED, and E-FACED were 7 (4.12), 2.36 (1.68), and 2.89 (2.03), respectively. There were 95 deaths during follow-up. The definition of the “frequent exacerbator patient” that presented the greatest predictive power for mortality was based on at least two exacerbations/year or one hospitalization/year (23.3% of patients; AUC-ROC: 0.75 [95% CI: 0.69–0.81]). Its predictive power was independent of the patient's initial severity. The clinical characteristics of the frequent exacerbator patient according to this definition varied according to the initial severity of bronchiectasis, presence of systemic inflammation, and treatment.

Conclusions

The combination of two exacerbations or one hospitalization per year is the definition of frequent exacerbator patient that has the best predictive value of mortality independent of the initial severity of bronchiectasis.

Keywords:
Bronchiectasis
Mortality
Exacerbations
Frequent exacerbator
BSI
FACED
E-FACED
Resumen
Introducción

Las bronquiectasias son una enfermedad muy heterogénea en la que se han identificado algunos grupos homogéneos con características clínicas y pronóstico similares. El objetivo de este estudio fue establecer la definición y características del “paciente exacerbador frecuente” que presenta mejor valor pronóstico y su relación con la gravedad de las bronquiectasias.

Métodos

Se analizó una cohorte histórica de 651 pacientes diagnosticados de bronquiectasias. Se siguió a todos ellos durante cinco años desde su diagnóstico radiológico. La exacerbación se definió como un empeoramiento de los síntomas de las bronquiectasias para el que se requiera tratamiento antibiótico. El principal resultado analizado fue la mortalidad por todas las causas al final del seguimiento.

Resultados

La edad media fue 48,2 (16) años (39,2% de hombres). El 38,9% tuvo infección por Pseudomonas aeruginosa. Los valores medios de BSI, FACED y E-FACED fueron 7 (4,12), 2,36 (1,68) y 2,89 (2,03), respectivamente. Hubo 96 muertes durante el seguimiento. La definición de “paciente exacerbador frecuente” que presentó el mayor valor predictivo para la mortalidad incluía la aparición de al menos dos exacerbaciones/año o un ingreso hospitalario/año (23.3% de los pacientes; AUC-ROC:0.75 [IC 95%: 0.69–0.81]). Su valor predictivo fue independiente de la gravedad inicial del paciente. Las características clínicas del “paciente exacerbador frecuente”, de acuerdo con esta definición, variaron según la gravedad inicial de la bronquiectasia, la presencia de inflamación sistémica y el tratamiento.

Conclusiones

La combinación de dos exacerbaciones o un ingreso hospitalario al año constituye la mejor definición de “paciente exacerbador frecuente” con mayor valor predictivo para la mortalidad, independientemente de la gravedad inicial de las bronquiectasias.

Palabras clave:
Bronquiectasias
Mortalidad
Exacerbaciones
Exacerbador frecuente
BSI
FACED
E-FACED

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