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Mortality in bronchiectasis: a long-term study assessing the factors influencing survival

M. R. Loebinger, A. U. Wells, D. M. Hansell, N. Chinyanganya, A. Devaraj, M. Meister, R. Wilson
European Respiratory Journal 2009 34: 843-849; DOI: 10.1183/09031936.00003709
M. R. Loebinger
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A. U. Wells
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D. M. Hansell
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N. Chinyanganya
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A. Devaraj
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M. Meister
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R. Wilson
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  • Article
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Figures

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  • Fig. 1—
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    Fig. 1—

    Flow diagram depicting patient selection. HRCT: high-resolution computed tomography.

  • Fig. 2—
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    Fig. 2—

    Kaplan–Meier plot illustrating the survival of all the bronchiectasis patients (––––), in addition to the idiopathic (·······) and known (– – – –) aetiology subgroups. There are no statistically significant differences between the plots (log rank test; p = 0.85).

Tables

  • Figures
  • Table 1—

    General characteristics of study patients with bronchiectasis

    Subjects n91
    Mortality dead/alive27 (29.7)/64 (70.3)
    Sex female/male53 (58.2)/38 (41.8)
    Smoker current/former/never1 (1.1)/20 (22)/70 (76.9)
    PSA/non-PSA20 (22)/71 (78)
    Age in 1994 yrs51.7±12.1
    Length of follow-up# months126.9±38.0
    Period between CT and LF months13.0±14.1
    CT criteria¶
     Bx extent33.1±21.0
     Dilatation severity39.7±24.8
     Wall thickness20.6±12.4
     Small airway plugging9.8±14.7
     Large airway plugging12.5±13.1
     Mosaicism7.5±10.2
     Emphysema3.9±8.0
    LF criteria % pred
     FEV165.8±28.1
     FVC88.7±23.6
     FEV1/FVC83.1±9.0
     RV136.8±44.1
     TLC103.1±16.6
     RV/TLC126.9±31.3
     TL,CO76.2±20.4
     KCO95.4±22.1
    Health-related quality of life questionnaire scores
     Fatigue4.7±2.4
     MRC wheeze+2.2±1.3
     MRC dyspnoea+2.2±1.0
     SGRQ total§45.9±18.1
     SGRQ symptoms§71.9±18.8
     SGRQ activities§49.1±24.5
     SGRQ impacts§35.7±19.0
    Aetiology
     Idiopathic51 (56)
     Post infective20 (22)
     ABPA8 (8.8)
     PCD5 (5.5)
     Young’s syndrome4 (4.4)
     Hypogammaglobulinaemia3 (3.3)
    • Data are presented as n (%) or mean±sd, unless otherwise stated. Data are presented from time of entry into the cohort. PSA: Pseudomonas aeruginosa; CT: computed tomography; LF: lung function; Bx: bronchiectasis; % pred: % predicted; FEV1: forced expiratory volume in 1 s; FVC: forced vital capacity; RV: residual volume; TLC: total lung capacity; TL,CO: transfer factor of the lung for carbon monoxide; KCO: transfer coefficient of the lung for carbon monoxide; MRC: Medical Research Council; SGRQ: St George’s Respiratory Questionnaire; ABPA: allergic bronchopulmonary aspergillosis; PCD: primary ciliary dyskinesia. #: from recruitment until March 1, 2007, or until patient died; ¶: expressed as a percentage of the maximal possible score for each criterion; +: range 1–5, with a score of 1 representing greatest breathlessness on strenuous exercise; §: range 0–100, with a zero score indicating no impairment in quality of life.

  • Table 2—

    Univariate Cox proportional hazard analysis

    ParametersRR (95% CI)#p-value
    Male sex1.96 (0.92–4.20)0.082
    Age1.06 (1.02–1.09)0.001
    Smoker1.78 (0.87–3.63)0.120
    PSA2.33 (1.04–5.18)0.039
    CT criteria
     Bx extent1.04 (1.02–1.05)<0.0005
     Dilatation severity1.03 (1.01–1.04)<0.0005
     Wall thickness1.07 (1.04–1.10)<0.0005
     Small airway plugging0.506
     Large airway plugging1.04 (1.02–1.07)0.002
     Mosaicism1.03 (1.00–1.06)0.049
     Emphysema1.05 (1.02–1.08)0.001
    LF criteria % pred
     FEV10.97 (0.95–0.98)<0.0005
     FVC0.98 (0.96–0.99)0.003
     FEV1/FVC0.209
     RV0.176
     TLC0.98 (0.96–1.01)0.192
     RV/TLC1.01 (1.00–1.02)0.021
     TL,CO0.95 (0.93–0.97)<0.0005
     KCO0.98 (0.97–0.99)0.007
    Health-related quality of life questionnaire scores
     Fatigue1.14 (0.97–1.35)0.122
     MRC wheeze1.26 (0.92–1.71)0.147
     MRC dyspnoea2.89 (1.84–4.54)<0.0005
     SGRQ total1.04 (1.01–1.06)0.002
     SGRQ symptoms1.02 (1.00–1.04)0.121
     SGRQ activities1.04 (1.02–1.06)<0.0005
     SGRQ impacts1.02 (1.00–1.04)0.035
    • RR: relative rate; CI: confidence interval; PSA: Pseudomonas aeruginosa; CT: computed tomography; Bx: bronchiectasis; LF: lung function; % pred: % predicted; FEV1: forced expiratory volume in 1 s; FVC: forced vital capacity; RV: residual volume; TLC: total lung capacity; TL,CO: transfer factor of the lung for carbon monoxide; KCO: transfer coefficient of the lung for carbon monoxide; MRC: Medical Research Council; SGRQ: St George’s Respiratory Questionnaire. #: RR >1 describes a positive correlation between the parameter and mortality, whereas RR <1 suggests a negative correlation. Entries in bold are statistically significant.

  • Table 3—

    Multivariate Cox proportional hazard stepwise analysis

    ParametersRR (95% CI)#p-value
    Age1.10 (1.06–1.15)<0.0005
    PSA3.61 (1.35–9.62)0.010
    Male sex3.42 (1.34–8.77)0.010
    LF criteria % pred
     RV/TLC1.03 (1.01–1.04)<0.0005
     TLC0.95 (0.93–0.98)<0.0005
     KCO0.96 (0.94–0.98)<0.0005
    Health-related quality of life questionnaire scores
     SGRQ activities1.05 (1.02–1.08)<0.0005
    • RR: relative rate; CI: confidence interval; PSA: Pseudomonas aeruginosa; LF: lung function; % pred: % predicted; RV: residual volume; TLC: total lung capacity; KCO: transfer coefficient for the lung for carbon monoxide; SGRQ: St George’s Respiratory Questionnaire. #: RR >1 describes a positive correlation between the parameter and mortality, whereas RR <1 suggests a negative correlation.

  • Table 4—

    Independent relationships between computed tomography measurements and the lung function measurements shown to correlate with mortality

    ParametersRC (95% CI)#p-value
    TLC % pred
     Mosaicism0.41 (0.06–0.75)0.02
    RV/TLC % pred log¶
     Wall thickness0.02 (0.01–0.02)<0.0005
     Mosaicism0.01 (0.01–0.02)0.001
    KCO % pred
     Emphysema-0.85 (-1.4– -0.30)0.003
    • RC: regression coefficient; CI: confidence interval; TLC: total lung capacity; % pred: % predicted; RV: residual volume; KCO: transfer coefficient of the lung for carbon monoxide. #: RC >0 describes a positive correlation between the parameter measurements, whereas RC <0 suggests a negative correlation; ¶: log transformed (log 56.93) to correct for skewness.

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Mortality in bronchiectasis: a long-term study assessing the factors influencing survival
M. R. Loebinger, A. U. Wells, D. M. Hansell, N. Chinyanganya, A. Devaraj, M. Meister, R. Wilson
European Respiratory Journal Oct 2009, 34 (4) 843-849; DOI: 10.1183/09031936.00003709

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Mortality in bronchiectasis: a long-term study assessing the factors influencing survival
M. R. Loebinger, A. U. Wells, D. M. Hansell, N. Chinyanganya, A. Devaraj, M. Meister, R. Wilson
European Respiratory Journal Oct 2009, 34 (4) 843-849; DOI: 10.1183/09031936.00003709
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