Risk factors for acute exacerbation in patients with bronchiectasis_Chinese Journal of Respiratory and Critical Care Medicine

Authors：

YANG Liqing ¹ ,  YANG Xiaodong ² , YANG Lijing ¹ , LU Qing ¹ , JI Jiaqi ¹

1. Department of Respiratory and Critical Care Medicine, Sichuan Academy of Medical Sciences, East Courtyard of Si Chuan Provincial People's Hospital, Chengdu, Sichuan 610100, P. R. China;
2. Department of Respiratory and Critical Care Medicine, West China Hospital, Sichuan University, Chengdu, Sichuan 610041, P. R. China;

Corresponding author：

YANG Xiaodong, Email: yang-xiaodong@163.com

Keywords：

Bronchiectasis; Acute exacerbation; Risk factors

DOI：

10.7507/1671-6205.201902004

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Objective To explorer the risk factors for acute exacerbation in patients with bronchiectasis within one year.Methods Four hundred and twenty-two patients with non-cystic fibrosis bronchiectasis hospitalized were enrolled in The East Region of the People’s hospital of Sichuan between October 2014 and October 2016. The patients’ clinical data were collected, and follow-up began at the time of discharged. The study endpoint was the first acute exacerbation, all patients were followed-up for one year after discharged. The patients were classified into two groups by the occurrence of acute exacerbation or no occurrence. Logistic regression analysis was used to explore the risk factors for acute exacerbation with bronchiectasis.Results The age, sick time, body mass index (BMI) less than 18.5 kg/m², smoking index, expectoration, hemoptysis, dyspnea, moist sounds, wheezing sounds, types of imaging, CT scores, lung lesion site, sputum culture, whether infected Pseudomonas aeruginosa, level of serum C-reactive protein (CRP), level of serum PCT, serum albumin, arterial carbon dioxide partial pressure, types of respiratory failure, combined with chronic cor pulmonale differed significantly between the two groups (P<0.05), while gender, history of Infection, smoking, cough, chest pain, fever, clubbed-finger, white blood cell counts, neutrophil counts, erythrocyte sedimentation rate, serum globulins, arterial oxygen partial pressure did not significantly differ (P>0.05). Multivariate Logistic regression analysis found that infection with Pseudomonas aeruginosa, BMI<18.5 kg/m², high level of serum CRP, high level of arterial carbon dioxide partial pressure (PaCO₂), high CT score with bronchiectasis, combination with chronic cor pulmonale were risk factors for acute exacerbation in patients with bronchiectasis (P<0.05).Conclusions Infection with pseudomonas aeruginosa, BMI < 18.5 kg/m², high serum CRP level, high arterial blood PaCO₂ level, high CT score with bronchiectasis and combination of chronic cor pulmonale are risk factors for acute aggravation within 1 year for patients with bronchiectasis. Doctors can identify these risk factors and intervene early, so as to reduce the acute exacerbation of bronchiectasis.

Citation： YANG Liqing, YANG Xiaodong, YANG Lijing, LU Qing, JI Jiaqi. Risk factors for acute exacerbation in patients with bronchiectasis. Chinese Journal of Respiratory and Critical Care Medicine, 2020, 19(6): 543-547. doi: 10.7507/1671-6205.201902004 Copy

1.	Goeminne P, Dupont L. Non cystic fibrosis bronchiectasis: diagnosis and management in 21^st century. Postgrad Med J, 2010, 86(1018): 493-501.
2.	段承祥, 潘纪戍, 张火俊. 支气管扩张症. 胸部疾病影像鉴别诊断. 北京: 中国协和医科大学出版社, 2010, 56-79.
3.	Reiff DB, Wells AU, Carr DH, et al. CT findings in bronchiectasis: limited value in distinguishing between idiopathic and specific types. Am J Roentgenol, 1995, 165(2): 261-267.
4.	成人支气管扩张症诊治专家共识编写组. 成人支气管扩张诊治专家共识. 中华结核和呼吸杂志, 2012, 35(7): 485-492.
5.	Kelly MG, Murphy S, Elborn JS, et al. Bronchiectasis in secondary care: a comprehensive profile of a neglected disease. Eur J Intern Med, 2003, 14(8): 488-492.
6.	Loebinger MR, Wells AU, Hansell DM, et al. Mortality in bronchiectasis a longterm study assessing the factors influencing survival. Eur Respir J, 2009, 34(4): 843-849.
7.	Seitz AE, Oliver KN, Steiner CA, et al. Trends and burden of bronchiectasis associated hospitalizations in the United States, 1993-2006. Chest, 2010, 138(4): 944-949.
8.	宋杰, 刘保清, 王金祥, 等. 493 例支气管扩张急性感染的细菌特点及药敏分析. 临床肺科杂志, 2012, 17(7): 1212-1214.
9.	蔺雪, 许西琳, 张红梅. 支气管扩张症稳定期下呼吸道细菌定植的研究. 中国实用医刊, 2014, 15: 28-29.
10.	Cole PJ. Inflammation: a two-edged sword--the model of bronchiectasis. Eur J Respir Dis Suppl, 1986, 147: 6-15.
11.	King PT, Holdsworth SR, Freezer NJ, et al. Characterisation of the onset and presenting clinical features of adult bronchiectasis. Respir Med, 2006, 100(12): 2183-2189.
12.	Polverino E, Goeminne PC, McDonnell MJ, et al. European Respiratory Society guidelines for the management of adult brochiecasis. Eur Respir J, 2017, 50(3): 1700629.
13.	Finch S, McDonell MJ, Abo-Leary H, et al. A comprehensive analysis of the impact of Pesudomonas aeruginosa colonization on prognosis in adult bronchiectasis. Ann Am Thorac Soc, 2015, 12(11): 1602-1611.
14.	Pasteur MC, Bilton D, Hill AT. British thoracic society bronchiectasis non-CF guideline group. British thoracic society guideline for non-CF bronchiectasis. Chest, 2010, 65 Suppl 1: i1-i58.
15.	Chalmers JD, Goeminne P, Aliberti S, et al. The bronchiectasis severity index. An international derivation and validation study. Am J Respir Crit Care Med, 2014, 189(5): 576-585.
16.	Oliveira MJ, Vaz D, Coutinho D, et al. Morbidity and risk factors for mortality in patients with acute exacerbation of bronchiectasis. Chest, 2014, 145(3): 430A-1-430A-2.
17.	Orriols R, Hernando R, Ferrer A, et al. Eradication therapy against Pesudomonas aeruginosa in non-cystic fibrosis bronchiectasis. Respiration, 2015, 90(4): 299-305.
18.	White L, Mirrani G, Grover M, et al. Outcomes of Pseudoonas eradication therapy in patients with non-cystic fibrosis bronchiectasis. Respir Med, 2015, 106(3): 356-360.
19.	焦瑞, 刘双. 支气管扩张急性加重的危险因素及意义. 中华医学杂志, 2015, 195(4): 272-276.
20.	Mao B, Lu HW, Li MH, et al. The existence of bronchiectasis predicts worse prognosis in patients with COPD. Sci Rep, 2015, 5: 10961.
21.	Martinez-Garcia MA, Soler-Cataluna JJ, Donat Sanz Y, et al. Factors associated with bronchiectasis in patients with COPD. Chest, 2011, 140(5): 1130-1137.
22.	Onen ZP, Gulbay BE, Sen E, et al. Analysis of the factors related in mortality in patients with bronchiectasis. Respir Med, 2007, 101(7): 1390-1397.

1. Goeminne P, Dupont L. Non cystic fibrosis bronchiectasis: diagnosis and management in 21^st century. Postgrad Med J, 2010, 86(1018): 493-501.
2. 段承祥, 潘纪戍, 张火俊. 支气管扩张症. 胸部疾病影像鉴别诊断. 北京: 中国协和医科大学出版社, 2010, 56-79.
3. Reiff DB, Wells AU, Carr DH, et al. CT findings in bronchiectasis: limited value in distinguishing between idiopathic and specific types. Am J Roentgenol, 1995, 165(2): 261-267.
4. 成人支气管扩张症诊治专家共识编写组. 成人支气管扩张诊治专家共识. 中华结核和呼吸杂志, 2012, 35(7): 485-492.
5. Kelly MG, Murphy S, Elborn JS, et al. Bronchiectasis in secondary care: a comprehensive profile of a neglected disease. Eur J Intern Med, 2003, 14(8): 488-492.
6. Loebinger MR, Wells AU, Hansell DM, et al. Mortality in bronchiectasis a longterm study assessing the factors influencing survival. Eur Respir J, 2009, 34(4): 843-849.
7. Seitz AE, Oliver KN, Steiner CA, et al. Trends and burden of bronchiectasis associated hospitalizations in the United States, 1993-2006. Chest, 2010, 138(4): 944-949.
8. 宋杰, 刘保清, 王金祥, 等. 493 例支气管扩张急性感染的细菌特点及药敏分析. 临床肺科杂志, 2012, 17(7): 1212-1214.
9. 蔺雪, 许西琳, 张红梅. 支气管扩张症稳定期下呼吸道细菌定植的研究. 中国实用医刊, 2014, 15: 28-29.
10. Cole PJ. Inflammation: a two-edged sword--the model of bronchiectasis. Eur J Respir Dis Suppl, 1986, 147: 6-15.
11. King PT, Holdsworth SR, Freezer NJ, et al. Characterisation of the onset and presenting clinical features of adult bronchiectasis. Respir Med, 2006, 100(12): 2183-2189.
12. Polverino E, Goeminne PC, McDonnell MJ, et al. European Respiratory Society guidelines for the management of adult brochiecasis. Eur Respir J, 2017, 50(3): 1700629.
13. Finch S, McDonell MJ, Abo-Leary H, et al. A comprehensive analysis of the impact of Pesudomonas aeruginosa colonization on prognosis in adult bronchiectasis. Ann Am Thorac Soc, 2015, 12(11): 1602-1611.
14. Pasteur MC, Bilton D, Hill AT. British thoracic society bronchiectasis non-CF guideline group. British thoracic society guideline for non-CF bronchiectasis. Chest, 2010, 65 Suppl 1: i1-i58.
15. Chalmers JD, Goeminne P, Aliberti S, et al. The bronchiectasis severity index. An international derivation and validation study. Am J Respir Crit Care Med, 2014, 189(5): 576-585.
16. Oliveira MJ, Vaz D, Coutinho D, et al. Morbidity and risk factors for mortality in patients with acute exacerbation of bronchiectasis. Chest, 2014, 145(3): 430A-1-430A-2.
17. Orriols R, Hernando R, Ferrer A, et al. Eradication therapy against Pesudomonas aeruginosa in non-cystic fibrosis bronchiectasis. Respiration, 2015, 90(4): 299-305.
18. White L, Mirrani G, Grover M, et al. Outcomes of Pseudoonas eradication therapy in patients with non-cystic fibrosis bronchiectasis. Respir Med, 2015, 106(3): 356-360.
19. 焦瑞, 刘双. 支气管扩张急性加重的危险因素及意义. 中华医学杂志, 2015, 195(4): 272-276.
20. Mao B, Lu HW, Li MH, et al. The existence of bronchiectasis predicts worse prognosis in patients with COPD. Sci Rep, 2015, 5: 10961.
21. Martinez-Garcia MA, Soler-Cataluna JJ, Donat Sanz Y, et al. Factors associated with bronchiectasis in patients with COPD. Chest, 2011, 140(5): 1130-1137.
22. Onen ZP, Gulbay BE, Sen E, et al. Analysis of the factors related in mortality in patients with bronchiectasis. Respir Med, 2007, 101(7): 1390-1397.

Chinese Journal of Respiratory and Critical Care Medicine

Risk factors for acute exacerbation in patients with bronchiectasis

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