Impact of bronchiectasis on outcomes of hospitalized patients with acute exacerbation of chronic obstructive pulmonary disease: A propensity matched analysis

Abstract

The coexistence of both Chronic Obstructive Pulmonary Disease (COPD) and bronchiectasis (BE) define an emerging phenotype with a worse prognosis; however, data about these patients do not consider baseline characteristics as confounders. We evaluate the impact of BE on outcomes of hospitalized patients with acute exacerbation of COPD (AECOPD). We prospectively considered AECOPD patients, analysed using a propensity score matching (PSM) method. The outcomes included length of hospital stay, use of non-invasive and invasive mechanical ventilation, intensive care unit admission, and mortality up to 3-years. Out of the 449 patients enrolled, 160 had associated BE. AECOPD with BE were older, had lower body mass index and greater functional impairment and severity of symptoms than AECOPD without BE. After PSM, 91 patients were considered for each group and no significant differences were found for all baseline characteristics. In full cohort, the cumulative mortality rate, the survival time, the Kaplan-Meier survival curves and the risk of death were worse in AECOPD with BE in the follow-up of 6-months, 1-year and 3-years. After PSM, data on mortality were similar between AECOPD with and without BE. In conclusion, in AECOPD patients the presence of BE does not influence mortality in a long-term follow-up.

Impact of Radiographic Bronchiectasis in COPD

“…Of all of these, 14 duplicates were removed. After reviewing the titles and abstracts, 76 full-text articles were identified and reviewed, and, finally, 18 studies 11,[17][18][19][20][21][22][23][24][25][26][27][28][29][30][31][32][33] were included in this systematic review and meta-analysis. The flow diagram of article selection according to the PRISMA guideline 13 is illustrated in Figure 1.…”

“…A total of 415,257 subjects with COPD from 18 observational studies 11,[17][18][19][20][21][22][23][24][25][26][27][28][29][30][31][32][33] were eligible for this meta-analysis, and bronchiectasis was present in 25,929 subjects (6.24%). The sample size ranged from 54 to 386,646, and 6 studies [17][18]20,22,25,33 had a small population (N < 100).…”

“…The sample size ranged from 54 to 386,646, and 6 studies [17][18]20,22,25,33 had a small population (N < 100). Ten studies 11,[17][18][19][20]25,[27][28][32][33] were prospective (cohort studies) and 8 [21][22][23][24]26,[29][30][31] were retrospective (case-control studies) in design. The minimum study duration lasted for 1 year and the maximum lasted for 10 years.…”

“…However, controversial results on some clinical outcomes still exist in recent studies. For example, Crisafulli et al 11 reported that, in subjects with COPD, the presence of bronchiectasis does not influence mortality in a long-term followup. Kawamatawong et al 12 found no significant association between lower airway bacterial colonization and the presence of bronchiectasis.…”

Hospitalized acute exacerbations of chronic obstructive pulmonary disease: which patients may have a negative clinical outcome?

“…Similarly, in the context of heart involvement during AECOPD, a recent study reported a significant negative role of intensive care unit admission or in-hospital mortality of pulmonary arterial enlargement defined by a pulmonary artery to aorta ratio >1 on chest computed tomography scan if associated with an increased troponin level (>0.01 ng/mL) [15]. Surprisingly, considering baseline characteristics as confounders using a propensity score matching method, the risk of death was similar in hospitalized AECOPD with and without bronchiectasis [16]. As for NIMV failure, non-invasive evaluation of DD at admission may also be a significant predictor of short-term mortality [9].…”