Vitamin-D deficiency is associated with chronic bacterial colonisation and disease severity in bronchiectasis

Chalmers, James D.; McHugh, Brian J.; Docherty, Catherine; Govan, John R. W.; Hill, Adam T.

doi:10.1136/thoraxjnl-2012-202125

Cited by 128 publications

(102 citation statements)

References 36 publications

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“…The primary objective of the original study was to evaluate predictors of outcome in bronchiectasis, including clinical and genetic predictors. As the goal of this present analysis was to derive a clinical prediction tool using routinely available clinical data, genetic predictors or biomarkers that are not widely available were excluded from the present analysis (13,14). Patients were excluded if they had active malignancy at enrollment, CF, active mycobacterial disease (including active nontuberculous mycobacteria [NTM]), HIV, or a primary diagnosis of pulmonary fibrosis/sarcoidosis with secondary traction bronchiectasis.…”

Section: Methods Derivation Cohortmentioning

confidence: 99%

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The Bronchiectasis Severity Index. An International Derivation and Validation Study

Chalmers

Goeminne²,

Aliberti

et al. 2014

Am J Respir Crit Care Med

818

836

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Rationale: There are no risk stratification tools for morbidity and mortality in bronchiectasis. Identifying patients at risk of exacerbations, hospital admissions, and mortality is vital for future research.Objectives: This study describes the derivation and validation of the Bronchiectasis Severity Index (BSI).Methods: Derivation of the BSI used data from a prospective cohort study (Edinburgh, UK, 2008 enrolling 608 patients. Cox proportional hazard regression was used to identify independent predictors of mortality and hospitalization over 4-year follow-up. The score was validated in independent cohorts from Dundee, UK (n = 218); Leuven, Belgium (n = 253); Monza, Italy (n = 105); and Newcastle, UK (n = 126).Measurements and Main Results: Independent predictors of future hospitalization were prior hospital admissions, Medical Research Council dyspnea score greater than or equal to 4, FEV 1 , 30% predicted, Pseudomonas aeruginosa colonization, colonization with other pathogenic organisms, and three or more lobes involved on high-resolution computed tomography. Independent predictors of mortality were older age, low FEV 1 , lower body mass index, prior hospitalization, and three or more exacerbations in the year before the study. The derived BSI predicted mortality and hospitalization: area under the receiver operator characteristic curve (AUC) 0.80 (95% confidence interval, 0.74-0.86) for mortality and AUC 0.88 (95% confidence interval, 0.84-0.91) for hospitalization, respectively.There was a clear difference in exacerbation frequency and quality of life using the St. George's Respiratory Questionnaire between patients classified as low, intermediate, and high risk by the score (P , 0.0001 for all comparisons). In the validation cohorts, the AUC for mortality ranged from 0.81 to 0.84 and for hospitalization from 0.80 to 0.88. Conclusions:The BSI is a useful clinical predictive tool that identifies patients at risk of future mortality, hospitalization, and exacerbations across healthcare systems.

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Section: Methods Derivation Cohortmentioning

confidence: 99%

“…The maximum score is 18 and minimum score is 1. This score has been used previously in studies of bronchiectasis (13)(14)(15)(16).…”

Section: Radiological Severitymentioning

confidence: 99%

The Bronchiectasis Severity Index. An International Derivation and Validation Study

Chalmers

Goeminne²,

Aliberti

et al. 2014

Am J Respir Crit Care Med

818

836

View full text Add to dashboard Cite

show abstract

“…Bronchiectasis has a clear attributable mortality. In the largest cohort study reported to date, 50% of patients died from respiratory causes, with around one-quarter dying from cardiovascular diseases [8]. LOEBINGER et al [9] provided long-term data on mortality by following up a cohort of patients first recruited for the validation of the St. Georges Respiratory Questionnaire (SGRQ) in 1994.…”

Section: How Common Is Bronchiectasis?mentioning

confidence: 99%

Management of bronchiectasis in adults

2015

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Formerly regarded as a rare disease, bronchiectasis is now increasingly recognised and a renewed interest in the condition is stimulating drug development and clinical research. Bronchiectasis represents the final common pathway of a number of infectious, genetic, autoimmune, developmental and allergic disorders and is highly heterogeneous in its aetiology, impact and prognosis.The goals of therapy should be: to improve airway mucus clearance through physiotherapy with or without adjunctive therapies; to suppress, eradicate and prevent airway bacterial colonisation; to reduce airway inflammation; and to improve physical functioning and quality of life.Fortunately, an increasing body of evidence supports interventions in bronchiectasis. The field has benefited greatly from the introduction of evidence-based guidelines in some European countries and randomised controlled trials have now demonstrated the benefit of long-term macrolide therapy, with accumulating evidence for inhaled therapies, physiotherapy and pulmonary rehabilitation.This review provides a critical update on the management of bronchiectasis focussing on emerging evidence and recent randomised controlled trials. @ERSpublications Bronchiectasis is a rapidly developing field: review of recent RCTs and progress towards developing new therapies

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“…This extends the earlier view that VitD is solely responsible for the regulation of calcium and phosphate metabolism. VitD deficiency is associated with respiratory tract infections such as tuberculosis (6,7), bronchiectasis (8), or pneumonia (9,10). Also, chronic obstructive pulmonary disease (COPD) and asthma are associated with low serum concentrations of VitD (11)(12)(13).…”

mentioning

confidence: 99%

Vitamin D Deficiency Does Not Result in a Breach of Host Defense in Murine Models of Pneumonia

et al. 2016

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bVitamin D (VitD) has a role in the regulation of calcium and phosphate metabolism and in addition impacts the activity of the immune system. VitD deficiency might be linked to increased susceptibility to respiratory tract infection. The aim of the present study was to characterize the impact of VitD deficiency on the susceptibility to bacterial infection in murine models. C57BL/6N mice were fed a diet with or without VitD for 10 weeks. The VitD-deficient or -sufficient mice were infected with Pseudomonas aeruginosa or Streptococcus pneumoniae. The colonization and inflammatory response in the lung were analyzed at defined time points. The serum 25-hydroxy-VitD concentration was significantly lower in mice on the VitD-deficient diet. In infection experiments with Pseudomonas aeruginosa or Streptococcus pneumoniae, no differences could be observed in the numbers of viable bacteria or in differential cell counts in the bronchoalveolar lavage fluids. Measurements of inflammatory cytokines (KC and interleukin-1␤ [IL-1␤]) did not show significant differences between the groups. In conclusion, VitD-deficient animals did not show significantly increased susceptibility to infection or an altered course of infection. The immune systems of humans and mice likely respond differently to VitD. Murine models are likely not appropriate for drawing conclusions on the role of VitD in human pulmonary host defense.

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Vitamin-D deficiency is associated with chronic bacterial colonisation and disease severity in bronchiectasis

Cited by 128 publications

References 36 publications

The Bronchiectasis Severity Index. An International Derivation and Validation Study

The Bronchiectasis Severity Index. An International Derivation and Validation Study

Management of bronchiectasis in adults

Vitamin D Deficiency Does Not Result in a Breach of Host Defense in Murine Models of Pneumonia

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