is responsible for chronic infection in many bronchiectasis patients but it is not known whether it is associated with worse clinical outcomes independent of the underlying severity of disease.This study analysed data from 2596 bronchiectasis patients included from 10 different bronchiectasis clinical centres across Europe and Israel, with a 5-year follow-up period. Prevalence of chronic infection and its independent impact on exacerbations, hospitalisations, quality of life and mortality was assessed.The prevalence of chronic infection was 15.0% (n=389). was associated with a higher mortality in a univariate analysis (hazard ratio (HR) 2.02; 95% (confidence interval) CI 1.53-2.66; p<0.0001) but an independent impact on mortality was not found in a multivariate analysis (HR 0.98; 95% CI 0.70-1.36; p=0.89). was independently associated with increased mortality only in patients with frequent exacerbations (two or more per year) (HR 2.03; 95% CI 1.36-3.03; p=0.001). An independent association with worse quality of life of 7.46 points (95% CI 2.93-12.00; p=0.001) was found in a multivariable linear regression. was therefore found to be independently associated with exacerbation frequency, hospital admissions and worse quality of life. Mortality was increased in patients with particularly in the presence of frequent exacerbations.

Bronchiectasis (BE) is a chronic and progressive respiratory disease with multiple possible causes [1,2]. Many require a specific therapy and thus, a systematic aetiologic evaluation is recommended by guidelines [3]. Studies have shown wide heterogeneity in the proportion of different aetiologies identified among centres [4][5][6][7][8], which can be partially justified because of geographical risks factors, but may also reflect variations in testing practice or in the definitions of aetiology used [9]. The proportion of patients classified as idiopathic varies (26-74%) across the literature, and this variability is likely to be somewhat linked to a lack of use of a standard aetiological algorithm [4][5][6][7][8].Variation in the assignment of aetiology influences every aspect of epidemiological research into BE, as well as clinical trials where the inclusion of patients with post-infective or idiopathic bronchiectasis is only meaningful if we have standardised methods of assigning these aetiologies [2]. The aim of this study was to create a BE aetiology classification algorithm that could be applied objectively to different healthcare settings. This algorithm was tested in a multicentre database of BE patients with the goal of improving the degree of agreement and alignment among different centres.

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Tuberculosis imposes high human and economic tolls, including in Europe. This study was conducted to develop a severity assessment tool for stratifying mortality risk in pulmonary tuberculosis (PTB) patients. A derivation cohort of 681 PTB cases was retrospectively reviewed to generate a model based on multiple logistic regression analysis of prognostic variables with 6-month mortality as the outcome measure. A clinical scoring system was developed and tested against a validation cohort of 103 patients. Five risk features were selected for the prediction model: hypoxemic respiratory failure (OR 4.7, 95% CI 2.8–7.9), age ≥50 years (OR 2.9, 95% CI 1.7–4.8), bilateral lung involvement (OR 2.5, 95% CI 1.4–4.4), ≥1 significant comorbidity—HIV infection, diabetes mellitus, liver failure or cirrhosis, congestive heart failure and chronic respiratory disease–(OR 2.3, 95% CI 1.3–3.8), and hemoglobin <12 g/dL (OR 1.8, 95% CI 1.1–3.1). A tuberculosis risk assessment tool (TReAT) was developed, stratifying patients with low (score ≤2), moderate (score 3–5) and high (score ≥6) mortality risk. The mortality associated with each group was 2.9%, 22.9% and 53.9%, respectively. The model performed equally well in the validation cohort. We provide a new, easy-to-use clinical scoring system to identify PTB patients with high-mortality risk in settings with good healthcare access, helping clinicians to decide which patients are in need of closer medical care during treatment.

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