支气管扩张症患者的合并症与死亡率风险：一项国际多中心队列研究。
Comorbidities and the risk of mortality in patients with bronchiectasis: an international multicentre cohort study.
机构信息
Department of Respiratory Medicine, Galway University Hospitals, Galway, Ireland; Institute of Cell and Molecular Biosciences and Institute for Cellular Medicine, Newcastle University, Newcastle-upon-Tyne, UK; Lung Biology Group, National University of Ireland, Galway, Ireland.
Department of Pathophysiology and Transplantation, University of Milan, Milan, Italy; Cardio-thoracic unit and Cystic Fibrosis Adult Center, Fondazione IRCCS Cà Granda Ospedale Maggiore Policlinico, Milan, Italy.
出版信息
Lancet Respir Med. 2016 Dec;4(12):969-979. doi: 10.1016/S2213-2600(16)30320-4. Epub 2016 Nov 16.
BACKGROUND
Patients with bronchiectasis often have concurrent comorbidities, but the nature, prevalence, and impact of these comorbidities on disease severity and outcome are poorly understood. We aimed to investigate comorbidities in patients with bronchiectasis and establish their prognostic value on disease severity and mortality rate.
METHODS
An international multicentre cohort analysis of outpatients with bronchiectasis from four European centres followed up for 5 years was done for score derivation. Eligible patients were those with bronchiectasis confirmed by high-resolution CT and a compatible clinical history. Comorbidity diagnoses were based on standardised definitions and were obtained from full review of paper and electronic medical records, prescriptions, and investigator definitions. Weibull parametric survival analysis was used to model the prediction of the 5 year mortality rate 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). The BACI was validated in two independent international cohorts from the UK and Serbia.
FINDINGS
Between June 1, 2006, and Nov 22, 2013, 1340 patients with bronchiectasis were screened and 986 patients were analysed. Patients had a median of four comorbidities (IQR 2-6; range 0-20). 13 comorbidities independently predicting mortality rate were integrated into the BACI. The overall hazard ratio for death conferred by a one-point increase in the BACI was 1·18 (95% CI 1·14-1·23; p<0·0001). The BACI predicted 5 year mortality rate, hospital admissions, exacerbations, and health-related quality of life across all BSI risk strata (p<0·0001 for mortality and hospital admissions, p=0·03 for exacerbations, p=0·0008 for quality of life). When used in conjunction with the BSI, the combined model was superior to either model alone (p=0·01 for combined vs BACI; p=0·008 for combined vs BSI).
INTERPRETATION
Multimorbidity is frequent in bronchiectasis and can negatively affect survival. The BACI complements the BSI in the assessment and prediction of mortality and disease outcomes in patients with bronchiectasis.
FUNDING
European Bronchiectasis Network (EMBARC).
背景
支气管扩张症患者常伴有并存的合并症，但这些合并症的性质、患病率及其对疾病严重程度和结局的影响仍不清楚。本研究旨在调查支气管扩张症患者的合并症，并确定其对疾病严重程度和死亡率的预后价值。
方法
对来自欧洲四个中心的门诊支气管扩张症患者进行国际多中心队列分析，随访 5 年以进行评分推导。符合条件的患者是那些通过高分辨率 CT 检查和临床病史证实患有支气管扩张症的患者。合并症的诊断基于标准化定义，并通过对纸质和电子病历、处方和研究者定义的全面审查获得。威布尔参数生存分析用于构建支气管扩张症病因学合并症指数（Bronchiectasis Aetiology Comorbidity Index，BACI）以预测 5 年死亡率。我们测试了 BACI 作为结局预测因子的能力，并探讨了当与支气管扩张症严重程度指数（Bronchiectasis Severity Index，BSI）联合使用时，BACI 是否能提供更多的预后信息。该指数在来自英国和塞尔维亚的两个独立国际队列中得到了验证。
结果
在 2006 年 6 月 1 日至 2013 年 11 月 22 日期间，对 1340 名支气管扩张症患者进行了筛查，其中 986 名患者进行了分析。患者的平均合并症数为 4 种（IQR 2-6；范围 0-20）。有 13 种独立预测死亡率的合并症被纳入 BACI。BACI 每增加 1 分，死亡的总体危险比为 1.18（95%CI 1.14-1.23；p<0.0001）。BACI 可预测 BSI 所有危险分层的 5 年死亡率、住院率、恶化率和健康相关生活质量（死亡率和住院率的 p<0.0001，恶化率的 p=0.03，生活质量的 p=0.0008）。当与 BSI 联合使用时，联合模型优于任一单独模型（联合模型与 BACI 相比，p=0.01；联合模型与 BSI 相比，p=0.008）。
解释
支气管扩张症患者合并症较为常见，可对生存率产生负面影响。BACI 可补充 BSI 对支气管扩张症患者死亡率和疾病结局的评估和预测。
资助
欧洲支气管扩张症网络（EMBARC）。
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