Comorbidities and the risk of mortality in patients with bronchiectasis: an international mulitcentre cohort study

Melissa J. McDonnell (Lead / Corresponding author), Stefano Aliberti, Pieter C. Goeminne, Marcos I. Restrepo, Simon Finch, Alberto Pesci, Lieven Dupont, Thomas Fardon, Robert Wilson, Michael Loebinger, Dusan Skrbic, Dusanka Obradovic, Anthony De Soyza, Chris Ward, John G. Laffey, Robert Rutherford, James Chalmers

Research output: Contribution to journalArticlepeer-review

97 Citations (Scopus)
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Abstract

Background: Patients with bronchiectasis often suffer from concurrent comorbidities but their nature, prevalence and impact on disease severity and outcome is poorly understood. We aimed to evaluate comorbidities in bronchiectasis patients and determine their prognostic value on disease severity and mortality.
Methods: An observational cohort analysis of 986 bronchiectasis patients across four European centres was performed for score derivation. Comorbidity diagnoses were based on standardised definitions obtained on full review of hard copy and electronic records, prescriptions and investigator definitions. Weibull parametric survival analysis was used to model the prediction of 5-year mortality to construct the Bronchiectasis Aetiology Comorbidity Index (BACI). We tested the BACI as a predictor of outcomes and explored whether the BACI added further prognostic information when used alongside the Bronchiectasis Severity Index (BSI).
Findings: Median number of comorbidities per patient was 4 (IQR 2-6), range 0-20. Thirteen comorbidities independently predicting mortality were integrated into the BACI. The overall hazard ratio for death conferred by a one point increase in the BACI was 1.18 (1.14-1.23), p<0.0001. The BACI predicted 5-year mortality, hospitalisations, exacerbations and health-related quality of life across all BSI risk strata (p<0.0001). When used in conjunction with the BSI, the combined model was superior to either model alone. The BACI was validated in two independent international cohorts.
Interpretation: Multimorbidity is frequent in bronchiectasis and can negatively influence survival. The BACI complements the BSI in assessing mortality and disease outcomes in patients with bronchiectasis.
Original languageEnglish
Pages (from-to)969-979
Number of pages11
JournalThe Lancet Respiratory Medicine
Volume4
Issue number12
Early online date15 Nov 2016
DOIs
Publication statusPublished - Dec 2016

Keywords

  • Comorbidity
  • bronchiectasis
  • severity
  • mortality

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