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Introduction: Identifying risk factors for poor outcomes can help with risk stratification and targeting of treatment. Risk factors for mortality and exacerbations have been identified in bronchiectasis but have been almost exclusively studied in European and North American populations. This study investigated the risk factors for poor outcome in a large population of bronchiectasis patients enrolled in India.
Methods: The EMBARC-India registry is a prospective observational study of adults with CT confirmed bronchiectasis enrolled at 31 sites across India. Baseline characteristics of patients were used to investigate associations with key clinical outcomes: Mortality, severe exacerbations requiring hospital admission, overall exacerbation frequency and FEV1 decline.
Results: 1018 patients with at least 12 months follow-up data were enrolled in the follow-up study. Frequent exacerbations (3 or more per year) at baseline were associated with an increased risk of mortality (hazard ratio(HR) 3.23 95%CI 1.39-7.50), severe exacerbations (HR 2.71 95%CI 1.92-3.83), future exacerbations (rate ratio(RR) 3.08 95%CI 2.36-4.01) and lung function decline. Co-existing COPD, dyspnoea and current cigarette smoking were similarly associated with a worse outcome across all endpoints studied. Additional predictors of mortality and severe exacerbations were increasing age and cardiovascular co-morbidity. Infection with Gram-negative pathogens (predominantly Klebsiella pneumoniae) was independently associated with increased mortality (HR 3.13 95%CI 1.62-6.06), while Pseudomonas aeruginosa infection was associated with severe exacerbations (HR 1.41 95%CI 1.01-1.97) and overall exacerbation rate (RR 1.47 95%CI 1.13-1.91).
Conclusion: This study identifies risk factors for morbidity and mortality among bronchiectasis patients in India. Identification of these risk factors may support treatment approaches optimised to an Asian setting.
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1/12/18 → 1/10/24
1/09/15 → 30/06/23