Influence of Comorbidities and Airway Clearance on Mortality and Outcomes of Patients With Severe Bronchiectasis Exacerbations in Taiwan
Bronchiectasis is characterized by systemic inflammation and multiple comorbidities. This study aimed to investigate the clinical outcomes based on the bronchiectasis etiology comorbidity index (BACI) score in patients hospitalized for severe bronchiectasis exacerbations. We included non-cystic fibr...
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Frontiers Media S.A.
2022-01-01
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| Online Access: | https://www.frontiersin.org/articles/10.3389/fmed.2021.812775/full |
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| author | Hung-Yu Huang Hung-Yu Huang Hung-Yu Huang Fu-Tsai Chung Fu-Tsai Chung Fu-Tsai Chung Fu-Tsai Chung Chun-Yu Lin Chun-Yu Lin Chun-Yu Lo Chun-Yu Lo Yu-Tung Huang Yu-Chen Huang Yu-Chen Huang Yu-Te Lai Shu-Ting Gan Po-Chuan Ko Horng-Chyuan Lin Horng-Chyuan Lin Kian Fan Chung Chun-Hua Wang Chun-Hua Wang |
| author_facet | Hung-Yu Huang Hung-Yu Huang Hung-Yu Huang Fu-Tsai Chung Fu-Tsai Chung Fu-Tsai Chung Fu-Tsai Chung Chun-Yu Lin Chun-Yu Lin Chun-Yu Lo Chun-Yu Lo Yu-Tung Huang Yu-Chen Huang Yu-Chen Huang Yu-Te Lai Shu-Ting Gan Po-Chuan Ko Horng-Chyuan Lin Horng-Chyuan Lin Kian Fan Chung Chun-Hua Wang Chun-Hua Wang |
| author_sort | Hung-Yu Huang |
| collection | DOAJ |
| description | Bronchiectasis is characterized by systemic inflammation and multiple comorbidities. This study aimed to investigate the clinical outcomes based on the bronchiectasis etiology comorbidity index (BACI) score in patients hospitalized for severe bronchiectasis exacerbations. We included non-cystic fibrosis patients hospitalized for severe bronchiectasis exacerbations between January 2008 and December 2016 from the Chang Gung Research Database (CGRD) cohort. The main outcome was the 1-year mortality rate after severe exacerbations. We used the Cox regression model to assess the risk factors of 1-year mortality. Of 1,235 patients who were hospitalized for severe bronchiectasis exacerbations, 641 were in the BACI < 6 group and 594 in the BACI ≥ 6 group. The BACI ≥ 6 group had more previous exacerbations and a lower FEV1. Pseudomonas aeruginosa (19.1%) was the most common bacterium, followed by Klebsiella pneumoniae (7.5%). Overall, 11.8% of patients had respiratory failure and the hospital mortality was 3.0%. After discharge, compared to the BACI < 6 group, the BACI ≥ 6 group had a significantly higher cumulative incidence of respiratory failure and mortality in a 1-year follow-up. The risk factors for 1-year mortality in a multivariate analysis include age [hazard ratio (HR) 4.38, p = 0.01], being male (HR 4.38, p = 0.01), and systemic corticosteroid usage (HR 6.35, p = 0.001), while airway clearance therapy (ACT) (HR 0.50, p = 0.010) was associated with a lower mortality risk. An increased risk of respiratory failure and mortality in a 1-year follow-up after severe exacerbations was observed in bronchiectasis patients with multimorbidities, particularly older age patients, male patients, and patients with a history of systemic corticosteroid use. ACT could effectively improve the risk for 1-year mortality. |
| first_indexed | 2024-12-20T10:20:23Z |
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| spelling | doaj.art-ce3e49bd1a9a4a3b96c65c7cc869dbc72022-12-21T19:43:56ZengFrontiers Media S.A.Frontiers in Medicine2296-858X2022-01-01810.3389/fmed.2021.812775812775Influence of Comorbidities and Airway Clearance on Mortality and Outcomes of Patients With Severe Bronchiectasis Exacerbations in TaiwanHung-Yu Huang0Hung-Yu Huang1Hung-Yu Huang2Fu-Tsai Chung3Fu-Tsai Chung4Fu-Tsai Chung5Fu-Tsai Chung6Chun-Yu Lin7Chun-Yu Lin8Chun-Yu Lo9Chun-Yu Lo10Yu-Tung Huang11Yu-Chen Huang12Yu-Chen Huang13Yu-Te Lai14Shu-Ting Gan15Po-Chuan Ko16Horng-Chyuan Lin17Horng-Chyuan Lin18Kian Fan Chung19Chun-Hua Wang20Chun-Hua Wang21Department of Thoracic Medicine, Chang Gung Memorial Hospital, Taipei, TaiwanCollege of Medicine, Chang Gung University, Taoyuan, TaiwanDepartment of Thoracic Medicine, New Taipei City Municipal TuCheng Hospital, Chang Gung Medical Foundation, New Taipei City, TaiwanDepartment of Thoracic Medicine, Chang Gung Memorial Hospital, Taipei, TaiwanCollege of Medicine, Chang Gung University, Taoyuan, TaiwanDepartment of Thoracic Medicine, New Taipei City Municipal TuCheng Hospital, Chang Gung Medical Foundation, New Taipei City, TaiwanDepartment of Respiratory Care, New Taipei City Municipal TuCheng Hospital, Chang Gung Medical Foundation, New Taipei City, TaiwanDepartment of Thoracic Medicine, Chang Gung Memorial Hospital, Taipei, TaiwanCollege of Medicine, Chang Gung University, Taoyuan, TaiwanDepartment of Thoracic Medicine, Chang Gung Memorial Hospital, Taipei, TaiwanCollege of Medicine, Chang Gung University, Taoyuan, TaiwanCenter for Big Data Analytics and Statistics, Chang Gung Memorial Hospital, Taoyuan, TaiwanDepartment of Thoracic Medicine, Chang Gung Memorial Hospital, Taipei, TaiwanCollege of Medicine, Chang Gung University, Taoyuan, TaiwanDivision of Pulmonary and Critical Care, Department of Internal Medicine, Saint Paul's Hospital, Taoyuan, TaiwanCenter for Big Data Analytics and Statistics, Chang Gung Memorial Hospital, Taoyuan, TaiwanCenter for Big Data Analytics and Statistics, Chang Gung Memorial Hospital, Taoyuan, TaiwanDepartment of Thoracic Medicine, Chang Gung Memorial Hospital, Taipei, TaiwanCollege of Medicine, Chang Gung University, Taoyuan, TaiwanBiomedical Research Unit, Experimental Studies, National Heart and Lung Institute, Imperial College London, Royal Brompton Hospital, London, United KingdomDepartment of Thoracic Medicine, Chang Gung Memorial Hospital, Taipei, TaiwanCollege of Medicine, Chang Gung University, Taoyuan, TaiwanBronchiectasis is characterized by systemic inflammation and multiple comorbidities. This study aimed to investigate the clinical outcomes based on the bronchiectasis etiology comorbidity index (BACI) score in patients hospitalized for severe bronchiectasis exacerbations. We included non-cystic fibrosis patients hospitalized for severe bronchiectasis exacerbations between January 2008 and December 2016 from the Chang Gung Research Database (CGRD) cohort. The main outcome was the 1-year mortality rate after severe exacerbations. We used the Cox regression model to assess the risk factors of 1-year mortality. Of 1,235 patients who were hospitalized for severe bronchiectasis exacerbations, 641 were in the BACI < 6 group and 594 in the BACI ≥ 6 group. The BACI ≥ 6 group had more previous exacerbations and a lower FEV1. Pseudomonas aeruginosa (19.1%) was the most common bacterium, followed by Klebsiella pneumoniae (7.5%). Overall, 11.8% of patients had respiratory failure and the hospital mortality was 3.0%. After discharge, compared to the BACI < 6 group, the BACI ≥ 6 group had a significantly higher cumulative incidence of respiratory failure and mortality in a 1-year follow-up. The risk factors for 1-year mortality in a multivariate analysis include age [hazard ratio (HR) 4.38, p = 0.01], being male (HR 4.38, p = 0.01), and systemic corticosteroid usage (HR 6.35, p = 0.001), while airway clearance therapy (ACT) (HR 0.50, p = 0.010) was associated with a lower mortality risk. An increased risk of respiratory failure and mortality in a 1-year follow-up after severe exacerbations was observed in bronchiectasis patients with multimorbidities, particularly older age patients, male patients, and patients with a history of systemic corticosteroid use. ACT could effectively improve the risk for 1-year mortality.https://www.frontiersin.org/articles/10.3389/fmed.2021.812775/fullbronchiectasisBACI indexsevere exacerbationairway clearance therapymortality |
| spellingShingle | Hung-Yu Huang Hung-Yu Huang Hung-Yu Huang Fu-Tsai Chung Fu-Tsai Chung Fu-Tsai Chung Fu-Tsai Chung Chun-Yu Lin Chun-Yu Lin Chun-Yu Lo Chun-Yu Lo Yu-Tung Huang Yu-Chen Huang Yu-Chen Huang Yu-Te Lai Shu-Ting Gan Po-Chuan Ko Horng-Chyuan Lin Horng-Chyuan Lin Kian Fan Chung Chun-Hua Wang Chun-Hua Wang Influence of Comorbidities and Airway Clearance on Mortality and Outcomes of Patients With Severe Bronchiectasis Exacerbations in Taiwan Frontiers in Medicine bronchiectasis BACI index severe exacerbation airway clearance therapy mortality |
| title | Influence of Comorbidities and Airway Clearance on Mortality and Outcomes of Patients With Severe Bronchiectasis Exacerbations in Taiwan |
| title_full | Influence of Comorbidities and Airway Clearance on Mortality and Outcomes of Patients With Severe Bronchiectasis Exacerbations in Taiwan |
| title_fullStr | Influence of Comorbidities and Airway Clearance on Mortality and Outcomes of Patients With Severe Bronchiectasis Exacerbations in Taiwan |
| title_full_unstemmed | Influence of Comorbidities and Airway Clearance on Mortality and Outcomes of Patients With Severe Bronchiectasis Exacerbations in Taiwan |
| title_short | Influence of Comorbidities and Airway Clearance on Mortality and Outcomes of Patients With Severe Bronchiectasis Exacerbations in Taiwan |
| title_sort | influence of comorbidities and airway clearance on mortality and outcomes of patients with severe bronchiectasis exacerbations in taiwan |
| topic | bronchiectasis BACI index severe exacerbation airway clearance therapy mortality |
| url | https://www.frontiersin.org/articles/10.3389/fmed.2021.812775/full |
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