Factors affecting mortality in bronchiectasis; FACED scoring

Aim: Bronchiectasis is a chronic inflammatory disease characterized by abnormal and permanent dilatation of the bronchi and bronchiole walls resulting from the destruction of elastic tissue and muscle structures. Persistent enlargement of the bronchial airways and decreased mucociliary activity contribute to mucus accumulation and bacterial invasion in the airways, resulting in recurrent infections. Due to chronic inflammation and recurrent infections in the airways, bronchiectasis causes lung function disorders and various complications that follow. As a result of all these disorders and complications, significant increases in mortality are observed. For this reason, scoring systems have been developed to guide the assessment of prognosis and mortality and to identify patients with frequent exacerbations. FACED scoring and Bronchiectasis Severity Index (BSI) are also among these scoring systems. In this study, it was aimed to determine the mortality rate in bronchiectasis, to evaluate the success of predicting mortality by comparing the FACED score with BSI, and to investigate the effect of the parameters in these scoring on mortality Materials and Methods: The demographic data, bronchiectasis diagnosis and followup times, comorbidities, smoking history, parameters of BSI and FACED scoring, scoring scores and degrees of bronchiectasis severity according to these scorings, 5-year mortality rates, 10-year and overall mortality rateof patients diagnosed with bronchiectasis, who applied to the relevant department of our university between January 2010 and December 2020 were examined. Cases were analyzed retrospectively according to database data. A total of 108 cases were included in the study, including 54 women and 54 men over the age of 18 with a diagnosis of bronchiectasis. Patients with diagnoses such as COPD, interstitial lung disease, malignancy, heart failure that would contribute to mortality were excluded from the study Results: The mean age of the patients was 62.70±16.07 years, 50% were male and 50% were female. 39.8% of the patients were smokers, 81.5% of the patients had a body mass index (BMI) value greater than 18.5 kg/m2 and additional disease was detected in 63.9% of the patients. The most common comorbidities were hypertension, atherosclerotic heart disease, asthma and diabetes mellitus. The overall mortality rate was 26.9%, the five-year mortality rate was 4.6%, and the ten-year mortality rate was 11.1%. The mean FEV1 values of the patients were low (64%), and the mean score of dyspnea according to mMRC was 2, and the mean number of lung lobes affected by bronchiectasis was 3. 52% of the patients had mild 5 bronchiectasis and %17.6 of the patients had severe bronchiectasis according to FACED scoring and 39.8% of the patients had severe bronchiectasis according to BSI. Pseudomonas aeruginosa colonization was present in 23.1% of the patients, 31.5% had a history of hospitalization in the last 2 years and 34.3% had a history of more than 2 exacerbations in the last 1 year. Male patients were older than females, and the rate of smoking was higher in males. The rate of having mild bronchiectasis according to BSI was higher in female patients, and the rate of having moderate bronchiectasis according to BSI was higher in male patients. The age of the deceased patients was higher than the surviving patients, and the rate of BMI values less than 18.5 kg/m2 in the deceased patients was higher than the surviving patients. The FEV1 values of the patients who died were lower than those who survived, and the mMRC levels of the patients who died were higher than those who survived. Patients who died had higher BSI and FACED scores than those who survived. According to the FACED scoring system, the severity of bronchiectasis was higher in the patients who died. According to BSI, the severity of bronchiectasis disease was more severe, and the rate of mild and moderate was lower. The rate of P.aeruginosa colonization, hospitalization in the last 2 years, and history of more than 2 exacerbations in the last 1 year was higher in patients who died. Age, BMI, FACED score, and exacerbation of more than two were found to be effective independent risk factors for mortality. It was determined that 1-year increase in the age of the patients (one year increase in age) increased mortality 1.1 times, BMI values lower than 18.5 increased 21,15 times, 1 point increase in total scores in FACED scoring 2.85 times, and the number of bronchiectasis exacerbations more than 2 in the previous year increased 19.71 times. The mean overall survival of the patients was 31.81±3.50 years. Survival was shorter in smokers, those with a BMI less than 18.5, those with a history of hospitalization in the last 2 years, and those with a history of more than 2 exacerbations in the last 1 year. Conclusion: In conclusion, bronchiectasis is a disease with high morbidity and mortality, and BSI and FACED scoring can be used to predict the prognosis and mortality risk of patients. Patients with moderate and severe bronchiectasis according to FACED scoring and severe bronchiectasis according to BSI have a significantly higher mortality risk. FACED scoring, which has fewer parameters than BSI, may be easier in terms of practical use.Age, 6 BMI, FACED scoring score, and more than two exacerbations in the last 1 year were found to be effective risk factors for mortality. Key Words: Bronchiectasis, BSI, FACED score, mortality, prognosis