Choate Radmila, Aksamit Timothy R, Mannino David, Addrizzo-Harris Doreen, Barker Alan, Basavaraj Ashwin, Daley Charles L, Daniels M Leigh Anne, Eden Edward, DiMango Angela, Fennelly Kevin, Griffith David E, Johnson Margaret M, Knowles Michael R, McShane Pamela J, Metersky Mark L, Noone Peadar G, O'Donnell Anne E, Olivier Kenneth N, Salathe Matthias A, Schmid Andreas, Thomashow Byron, Tino Gregory, Winthrop Kevin L, Stone Glenda
University of Kentucky, College of Public Health, Lexington, KY, USA; Research, COPD Foundation, USA.
Pulmonary Disease and Critical Care Medicine, Mayo Clinic, Rochester, MN, USA.
Respir Med. 2021 Feb;177:106285. doi: 10.1016/j.rmed.2020.106285. Epub 2020 Dec 24.
Non-cystic fibrosis bronchiectasis (NCFB) is characterized by dilated bronchi, poor mucus clearance and susceptibility to bacterial infection. Pseudomonas aeruginosa (PA) is one of the most frequently isolated pathogens in patients with NCFB. The purpose of this study was to evaluate the association between presence of PA and disease severity in patients within the US Bronchiectasis and Nontuberculous mycobacteria (NTM) Research Registry (BRR).
Baseline US BRR data from adult patients with NCFB collected between 2008 and 2018 was used for this study. The presence of PA was defined as one or more positive PA cultures within two years prior to enrollment. Modified Bronchiectasis Severity Index (m-BSI) and modified FACED (m-FACED) were computed to evaluate severity of bronchiectasis. Unadjusted and multivariable multinomial regression models were used to assess the association between presence of PA and severity of bronchiectasis.
Average age of the study participants (n = 1831) was 63.7 years (SD = 14.1), 91.5% white, and 78.8% female. Presence of PA was identified in 25.4% of the patients. Patients with presence of PA had significantly lower mean pre-bronchodilator FEV1% predicted compared to those without PA (62.8% vs. 73.7%, p < .0001). In multivariate analyses, patients with presence of PA had significantly greater odds for having high (OR = 6.15 (95%CI:3.98-9.50) and intermediate (OR = 2.06 (95%CI:1.37-3.09) severity vs. low severity on m-BSI.
The presence of PA is common in patients with NCFB within the Bronchiectasis and NTM Research Registry. Severity of bronchiectasis is significantly greater in patients with PA which emphasizes high burden of the disease.
非囊性纤维化支气管扩张症（NCFB）的特征为支气管扩张、黏液清除功能差以及易受细菌感染。铜绿假单胞菌（PA）是NCFB患者中最常分离出的病原体之一。本研究的目的是评估美国支气管扩张症与非结核分枝杆菌（NTM）研究注册中心（BRR）内患者PA的存在与疾病严重程度之间的关联。
本研究使用了2008年至2018年间收集的成年NCFB患者的美国BRR基线数据。PA的存在定义为入组前两年内一次或多次PA培养阳性。计算改良支气管扩张严重指数（m-BSI）和改良FACED（m-FACED）以评估支气管扩张的严重程度。使用未调整和多变量多项回归模型评估PA的存在与支气管扩张严重程度之间的关联。
研究参与者（n = 1831）的平均年龄为63.7岁（标准差 = 14.1），91.5%为白人，78.8%为女性。25.4%的患者检测到PA的存在。与无PA的患者相比，有PA的患者支气管扩张前FEV1%预测值的平均水平显著更低（62.8%对73.7%，p <.0001）。在多变量分析中，有PA的患者在m-BSI上具有高严重程度（OR = 6.15（95%CI：3.98 - 9.50））和中度严重程度（OR = 2.06（95%CI：1.37 - 3.09））的几率显著高于低严重程度。
在支气管扩张症和NTM研究注册中心内，PA的存在在NCFB患者中很常见。PA患者的支气管扩张严重程度显著更高，这突出了该疾病的高负担。
