Clinical outcomes of bronchiectasis in India: data from the EMBARC/Respiratory research network of India registry

Raja Dhar; Sheetu Singh; Deepak Talwar; Murali Mohan Bv; Surya Kant Tripathi; Rajesh Swarnakar; Sonali Trivedi; Srinivas Rajagopala; George D'Souza; Arjun Padmanabhan; B. Archana; Mahesh PA; Babaji Ghewade; Girija Nair; Aditya Jindal; Gayathri Devi H Jayadevappa; Honney Sawhney; Kripesh Ranjan Sarmah; Kaushik Saha; Suresh Anantharaj; Arjun Khanna; Samir Gami; Arti Shah; Arpan Shah; Naveen Dutt; Himanshu Garg; Sunil Vyas; Kummannoor Venugopal; Rajendra Prasad; Naveed M Aleemuddin; Saurabh Karmakar; Virendra Singh; S K Jindal; Shubham Sharma; Deepak Prajapat; Sagar Chandrashekar; Michael Loebinger; Aditi Mishra; Francesco Blasi; Ramanathan Palaniappan Ramanathan; Pieter C. Goeminne; Preethi Vasudev; Amelia Shoemark; B. S. Jayaraj; Rahul Kungwani; Akanksha Das; Mehneet Sawhney; Eva Polverino; Megan L. Crichton; Sneha  Limaye; Sundeep Salvi; James D. Chalmers

doi:10.1183/13993003.00611-2022

Clinical outcomes of bronchiectasis in India: data from the EMBARC/Respiratory research network of India registry

, Raja Dhar, Sheetu Singh, Deepak Talwar, Murali Mohan Bv, Surya Kant Tripathi, Rajesh Swarnakar, Sonali Trivedi, Srinivas Rajagopala, George D'Souza, Arjun Padmanabhan, B. Archana, Mahesh PA, Babaji Ghewade, Girija Nair, Aditya Jindal, Gayathri Devi H Jayadevappa, Honney Sawhney, Kripesh Ranjan Sarmah, Kaushik SahaSuresh Anantharaj, Arjun Khanna, Samir Gami, Arti Shah, Arpan Shah, Naveen Dutt, Himanshu Garg, Sunil Vyas, Kummannoor Venugopal, Rajendra Prasad, Naveed M Aleemuddin, Saurabh Karmakar, Virendra Singh, S K Jindal, Shubham Sharma, Deepak Prajapat, Sagar Chandrashekar, Michael Loebinger, Aditi Mishra, Francesco Blasi, Ramanathan Palaniappan Ramanathan, Pieter C. Goeminne, Preethi Vasudev, Amelia Shoemark, B. S. Jayaraj, Rahul Kungwani, Akanksha Das, Mehneet Sawhney, Eva Polverino, Megan L. Crichton, Sneha Limaye, Sundeep Salvi, James D. Chalmers (Lead / Corresponding author)

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Abstract

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.

Original language	English
Article number	2200611
Number of pages	12
Journal	European Respiratory Journal
Volume	61
Early online date	13 Oct 2022
DOIs	https://doi.org/10.1183/13993003.00611-2022
Publication status	Published - 2023

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10.1183/13993003.00611-2022Licence: CC BY-NC

Final published versionFinal published version, 954 KBLicence: CC BY-NC

1 Finished
1 Active

EMBARC2 - European Bronchiectasis Registry and Biobank
Chalmers, J. (Investigator)
European Respiratory Society
1/12/18 → 30/09/26
Project: Research
Inhaled Antibiotics in Bronchiectasis and Cystic Fibrosis (iABC) (Joint with 19 Partners)
Chalmers, J. (Investigator) & Shoemark, A. (Investigator)
COMMISSION OF THE EUROPEAN COMMUNITIES
1/09/15 → 30/06/23
Project: Research

Cite this

, Dhar, R., Singh, S., Talwar, D., Bv, M. M., Kant Tripathi, S., Swarnakar, R., Trivedi, S., Rajagopala, S., D'Souza, G., Padmanabhan, A., Archana, B., PA, M., Ghewade, B., Nair, G., Jindal, A., Jayadevappa, G. D. H., Sawhney, H., Ranjan Sarmah, K., ... Chalmers, J. D. (2023). Clinical outcomes of bronchiectasis in India: data from the EMBARC/Respiratory research network of India registry. European Respiratory Journal, 61, Article 2200611. https://doi.org/10.1183/13993003.00611-2022

@article{a40380469ada4b179e1c61c8027070ab,

title = "Clinical outcomes of bronchiectasis in India: data from the EMBARC/Respiratory research network of India registry",

abstract = "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.",

author = "Raja Dhar and Sheetu Singh and Deepak Talwar and Bv, {Murali Mohan} and {Kant Tripathi}, Surya and Rajesh Swarnakar and Sonali Trivedi and Srinivas Rajagopala and George D'Souza and Arjun Padmanabhan and B. Archana and Mahesh PA and Babaji Ghewade and Girija Nair and Aditya Jindal and Jayadevappa, {Gayathri Devi H} and Honney Sawhney and {Ranjan Sarmah}, Kripesh and Kaushik Saha and Suresh Anantharaj and Arjun Khanna and Samir Gami and Arti Shah and Arpan Shah and Naveen Dutt and Himanshu Garg and Sunil Vyas and Kummannoor Venugopal and Rajendra Prasad and Aleemuddin, {Naveed M} and Saurabh Karmakar and Virendra Singh and Jindal, {S K} and Shubham Sharma and Deepak Prajapat and Sagar Chandrashekar and Michael Loebinger and Aditi Mishra and Francesco Blasi and {Palaniappan Ramanathan}, Ramanathan and Goeminne, {Pieter C.} and Preethi Vasudev and Amelia Shoemark and Jayaraj, {B. S.} and Rahul Kungwani and Akanksha Das and Mehneet Sawhney and Eva Polverino and Crichton, {Megan L.} and Sneha Limaye and Sundeep Salvi and Chalmers, {James D.}",

note = "Copyright: {\textcopyright}The authors 2023",

year = "2023",

doi = "10.1183/13993003.00611-2022",

language = "English",

volume = "61",

journal = "European Respiratory Journal",

issn = "0903-1936",

publisher = "European Respiratory Society",

}

Dhar, R, Singh, S, Talwar, D, Bv, MM, Kant Tripathi, S, Swarnakar, R, Trivedi, S, Rajagopala, S, D'Souza, G, Padmanabhan, A, Archana, B, PA, M, Ghewade, B, Nair, G, Jindal, A, Jayadevappa, GDH, Sawhney, H, Ranjan Sarmah, K, Saha, K, Anantharaj, S, Khanna, A, Gami, S, Shah, A, Shah, A, Dutt, N, Garg, H, Vyas, S, Venugopal, K, Prasad, R, Aleemuddin, NM, Karmakar, S, Singh, V, Jindal, SK, Sharma, S, Prajapat, D, Chandrashekar, S, Loebinger, M, Mishra, A, Blasi, F, Palaniappan Ramanathan, R, Goeminne, PC, Vasudev, P, Shoemark, A, Jayaraj, BS, Kungwani, R, Das, A, Sawhney, M, Polverino, E, Crichton, ML, Limaye, S & Salvi, S & Chalmers, JD 2023, 'Clinical outcomes of bronchiectasis in India: data from the EMBARC/Respiratory research network of India registry', European Respiratory Journal, vol. 61, 2200611. https://doi.org/10.1183/13993003.00611-2022

TY - JOUR

T1 - Clinical outcomes of bronchiectasis in India

T2 - data from the EMBARC/Respiratory research network of India registry

AU - Dhar, Raja

AU - Singh, Sheetu

AU - Talwar, Deepak

AU - Bv, Murali Mohan

AU - Kant Tripathi, Surya

AU - Swarnakar, Rajesh

AU - Trivedi, Sonali

AU - Rajagopala, Srinivas

AU - D'Souza, George

AU - Padmanabhan, Arjun

AU - Archana, B.

AU - PA, Mahesh

AU - Ghewade, Babaji

AU - Nair, Girija

AU - Jindal, Aditya

AU - Jayadevappa, Gayathri Devi H

AU - Sawhney, Honney

AU - Ranjan Sarmah, Kripesh

AU - Saha, Kaushik

AU - Anantharaj, Suresh

AU - Khanna, Arjun

AU - Gami, Samir

AU - Shah, Arti

AU - Shah, Arpan

AU - Dutt, Naveen

AU - Garg, Himanshu

AU - Vyas, Sunil

AU - Venugopal, Kummannoor

AU - Prasad, Rajendra

AU - Aleemuddin, Naveed M

AU - Karmakar, Saurabh

AU - Singh, Virendra

AU - Jindal, S K

AU - Sharma, Shubham

AU - Prajapat, Deepak

AU - Chandrashekar, Sagar

AU - Loebinger, Michael

AU - Mishra, Aditi

AU - Blasi, Francesco

AU - Palaniappan Ramanathan, Ramanathan

AU - Goeminne, Pieter C.

AU - Vasudev, Preethi

AU - Shoemark, Amelia

AU - Jayaraj, B. S.

AU - Kungwani, Rahul

AU - Das, Akanksha

AU - Sawhney, Mehneet

AU - Polverino, Eva

AU - Crichton, Megan L.

AU - Limaye, Sneha

AU - Salvi, Sundeep

AU - Chalmers, James D.

PY - 2023

Y1 - 2023

N2 - 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.

AB - 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.

U2 - 10.1183/13993003.00611-2022

DO - 10.1183/13993003.00611-2022

M3 - Article

C2 - 36229049

SN - 0903-1936

VL - 61

JO - European Respiratory Journal

JF - European Respiratory Journal

M1 - 2200611

ER -

Clinical outcomes of bronchiectasis in India: data from the EMBARC/Respiratory research network of India registry

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EMBARC2 - European Bronchiectasis Registry and Biobank

Inhaled Antibiotics in Bronchiectasis and Cystic Fibrosis (iABC) (Joint with 19 Partners)

Cite this