Bronchiectasis Rheumatoid Overlap Syndrome Is an Independent Risk Factor for Mortality in Patients With Bronchiectasis: A Multicenter Cohort Study

Anthony De Soyza; Melissa J. McDonnell; Pieter C. Goeminne; Stefano Aliberti; Sara Lonni; John Davison; Lieven J. Dupont; Thomas C. Fardon; Robert M. Rutherford; Adam T. Hill; James D. Chalmers

doi:10.1016/j.chest.2016.12.024

Bronchiectasis Rheumatoid Overlap Syndrome Is an Independent Risk Factor for Mortality in Patients With Bronchiectasis: A Multicenter Cohort Study

Anthony De Soyza, Melissa J. McDonnell, Pieter C. Goeminne, Stefano Aliberti, Sara Lonni, John Davison, Lieven J. Dupont, Thomas C. Fardon, Robert M. Rutherford, Adam T. Hill, James D. Chalmers

Undergraduate Medicine

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Abstract

Background: This study assessed if bronchiectasis (BR) and rheumatoid arthritis (RA), when manifesting as an overlap syndrome (BROS), were associated with worse outcomes than other BR etiologies applying the Bronchiectasis Severity Index (BSI).

Methods: Data were collected from the BSI databases of 1,716 adult patients with BR across six centers: Edinburgh, United Kingdom (608 patients); Dundee, United Kingdom (n = 286); Leuven, Belgium (n = 253); Monza, Italy (n = 201); Galway, Ireland (n = 242); and Newcastle, United Kingdom (n = 126). Patients were categorized as having BROS (those with RA and BR without interstitial lung disease), idiopathic BR, bronchiectasis-COPD overlap syndrome (BCOS), and “other” BR etiologies. Mortality rates, hospitalization, and exacerbation frequency were recorded.

Results: A total of 147 patients with BROS (8.5% of the cohort) were identified. There was a statistically significant relationship between BROS and mortality, although this relationship was not associated with higher rates of BR exacerbations or BR-related hospitalizations. The mortality rate over a mean of 48 months was 9.3% for idiopathic BR, 8.6% in patients with other causes of BR, 18% for RA, and 28.5% for BCOS. Mortality was statistically higher in patients with BROS and BCOS compared with those with all other etiologies. The BSI scores were statistically but not clinically significantly higher in those with BROS compared with those with idiopathic BR (BSI mean, 7.7 vs 7.1, respectively; P < .05). Patients with BCOS had significantly higher BSI scores (mean, 10.4), Pseudomonas aeruginosa colonization rates (24%), and previous hospitalization rates (58%).

Conclusions: Both the BROS and BCOS groups have an excess of mortality. The mechanisms for this finding may be complex, but these data emphasize that these subgroups require additional study to understand this excess mortality.

Original language	English
Pages (from-to)	1247-1254
Number of pages	8
Journal	Chest
Volume	151
Issue number	6
Early online date	16 Jan 2017
DOIs	https://doi.org/10.1016/j.chest.2016.12.024
Publication status	Published - Jun 2017

Keywords

bronchiectasis
COPD
mortality
rheumatoid arthritis

ASJC Scopus subject areas

Pulmonary and Respiratory Medicine
Critical Care and Intensive Care Medicine
Cardiology and Cardiovascular Medicine

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Cite this

De Soyza, A., McDonnell, M. J., Goeminne, P. C., Aliberti, S., Lonni, S., Davison, J., Dupont, L. J., Fardon, T. C., Rutherford, R. M., Hill, A. T., & Chalmers, J. D. (2017). Bronchiectasis Rheumatoid Overlap Syndrome Is an Independent Risk Factor for Mortality in Patients With Bronchiectasis: A Multicenter Cohort Study. Chest, 151(6), 1247-1254. https://doi.org/10.1016/j.chest.2016.12.024

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title = "Bronchiectasis Rheumatoid Overlap Syndrome Is an Independent Risk Factor for Mortality in Patients With Bronchiectasis: A Multicenter Cohort Study",

abstract = "Background: This study assessed if bronchiectasis (BR) and rheumatoid arthritis (RA), when manifesting as an overlap syndrome (BROS), were associated with worse outcomes than other BR etiologies applying the Bronchiectasis Severity Index (BSI).Methods: Data were collected from the BSI databases of 1,716 adult patients with BR across six centers: Edinburgh, United Kingdom (608 patients); Dundee, United Kingdom (n = 286); Leuven, Belgium (n = 253); Monza, Italy (n = 201); Galway, Ireland (n = 242); and Newcastle, United Kingdom (n = 126). Patients were categorized as having BROS (those with RA and BR without interstitial lung disease), idiopathic BR, bronchiectasis-COPD overlap syndrome (BCOS), and “other” BR etiologies. Mortality rates, hospitalization, and exacerbation frequency were recorded.Results: A total of 147 patients with BROS (8.5% of the cohort) were identified. There was a statistically significant relationship between BROS and mortality, although this relationship was not associated with higher rates of BR exacerbations or BR-related hospitalizations. The mortality rate over a mean of 48 months was 9.3% for idiopathic BR, 8.6% in patients with other causes of BR, 18% for RA, and 28.5% for BCOS. Mortality was statistically higher in patients with BROS and BCOS compared with those with all other etiologies. The BSI scores were statistically but not clinically significantly higher in those with BROS compared with those with idiopathic BR (BSI mean, 7.7 vs 7.1, respectively; P < .05). Patients with BCOS had significantly higher BSI scores (mean, 10.4), Pseudomonas aeruginosa colonization rates (24%), and previous hospitalization rates (58%).Conclusions: Both the BROS and BCOS groups have an excess of mortality. The mechanisms for this finding may be complex, but these data emphasize that these subgroups require additional study to understand this excess mortality.",

keywords = "bronchiectasis, COPD, mortality, rheumatoid arthritis",

author = "{De Soyza}, Anthony and McDonnell, {Melissa J.} and Goeminne, {Pieter C.} and Stefano Aliberti and Sara Lonni and John Davison and Dupont, {Lieven J.} and Fardon, {Thomas C.} and Rutherford, {Robert M.} and Hill, {Adam T.} and Chalmers, {James D.}",

year = "2017",

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De Soyza, A, McDonnell, MJ, Goeminne, PC, Aliberti, S, Lonni, S, Davison, J, Dupont, LJ, Fardon, TC, Rutherford, RM, Hill, AT & Chalmers, JD 2017, 'Bronchiectasis Rheumatoid Overlap Syndrome Is an Independent Risk Factor for Mortality in Patients With Bronchiectasis: A Multicenter Cohort Study', Chest, vol. 151, no. 6, pp. 1247-1254. https://doi.org/10.1016/j.chest.2016.12.024

TY - JOUR

T1 - Bronchiectasis Rheumatoid Overlap Syndrome Is an Independent Risk Factor for Mortality in Patients With Bronchiectasis

T2 - A Multicenter Cohort Study

AU - De Soyza, Anthony

AU - McDonnell, Melissa J.

AU - Goeminne, Pieter C.

AU - Aliberti, Stefano

AU - Lonni, Sara

AU - Davison, John

AU - Dupont, Lieven J.

AU - Fardon, Thomas C.

AU - Rutherford, Robert M.

AU - Hill, Adam T.

AU - Chalmers, James D.

PY - 2017/6

Y1 - 2017/6

N2 - Background: This study assessed if bronchiectasis (BR) and rheumatoid arthritis (RA), when manifesting as an overlap syndrome (BROS), were associated with worse outcomes than other BR etiologies applying the Bronchiectasis Severity Index (BSI).Methods: Data were collected from the BSI databases of 1,716 adult patients with BR across six centers: Edinburgh, United Kingdom (608 patients); Dundee, United Kingdom (n = 286); Leuven, Belgium (n = 253); Monza, Italy (n = 201); Galway, Ireland (n = 242); and Newcastle, United Kingdom (n = 126). Patients were categorized as having BROS (those with RA and BR without interstitial lung disease), idiopathic BR, bronchiectasis-COPD overlap syndrome (BCOS), and “other” BR etiologies. Mortality rates, hospitalization, and exacerbation frequency were recorded.Results: A total of 147 patients with BROS (8.5% of the cohort) were identified. There was a statistically significant relationship between BROS and mortality, although this relationship was not associated with higher rates of BR exacerbations or BR-related hospitalizations. The mortality rate over a mean of 48 months was 9.3% for idiopathic BR, 8.6% in patients with other causes of BR, 18% for RA, and 28.5% for BCOS. Mortality was statistically higher in patients with BROS and BCOS compared with those with all other etiologies. The BSI scores were statistically but not clinically significantly higher in those with BROS compared with those with idiopathic BR (BSI mean, 7.7 vs 7.1, respectively; P < .05). Patients with BCOS had significantly higher BSI scores (mean, 10.4), Pseudomonas aeruginosa colonization rates (24%), and previous hospitalization rates (58%).Conclusions: Both the BROS and BCOS groups have an excess of mortality. The mechanisms for this finding may be complex, but these data emphasize that these subgroups require additional study to understand this excess mortality.

AB - Background: This study assessed if bronchiectasis (BR) and rheumatoid arthritis (RA), when manifesting as an overlap syndrome (BROS), were associated with worse outcomes than other BR etiologies applying the Bronchiectasis Severity Index (BSI).Methods: Data were collected from the BSI databases of 1,716 adult patients with BR across six centers: Edinburgh, United Kingdom (608 patients); Dundee, United Kingdom (n = 286); Leuven, Belgium (n = 253); Monza, Italy (n = 201); Galway, Ireland (n = 242); and Newcastle, United Kingdom (n = 126). Patients were categorized as having BROS (those with RA and BR without interstitial lung disease), idiopathic BR, bronchiectasis-COPD overlap syndrome (BCOS), and “other” BR etiologies. Mortality rates, hospitalization, and exacerbation frequency were recorded.Results: A total of 147 patients with BROS (8.5% of the cohort) were identified. There was a statistically significant relationship between BROS and mortality, although this relationship was not associated with higher rates of BR exacerbations or BR-related hospitalizations. The mortality rate over a mean of 48 months was 9.3% for idiopathic BR, 8.6% in patients with other causes of BR, 18% for RA, and 28.5% for BCOS. Mortality was statistically higher in patients with BROS and BCOS compared with those with all other etiologies. The BSI scores were statistically but not clinically significantly higher in those with BROS compared with those with idiopathic BR (BSI mean, 7.7 vs 7.1, respectively; P < .05). Patients with BCOS had significantly higher BSI scores (mean, 10.4), Pseudomonas aeruginosa colonization rates (24%), and previous hospitalization rates (58%).Conclusions: Both the BROS and BCOS groups have an excess of mortality. The mechanisms for this finding may be complex, but these data emphasize that these subgroups require additional study to understand this excess mortality.

KW - bronchiectasis

KW - COPD

KW - mortality

KW - rheumatoid arthritis

UR - http://www.scopus.com/inward/record.url?scp=85020903130&partnerID=8YFLogxK

U2 - 10.1016/j.chest.2016.12.024

DO - 10.1016/j.chest.2016.12.024

M3 - Article

C2 - 28093268

AN - SCOPUS:85020903130

SN - 0012-3692

VL - 151

SP - 1247

EP - 1254

JO - Chest

JF - Chest

IS - 6

ER -