Determination of factors associated with number of attacks,hospitalization and mortality in adult bronchiectasis patients with NON-cystic fibrosis

Objective: The aim of this study was to determine the number of attacks, hospitalizations and factors associated with mortality in adult non-cystic fibrosis bronchiectasis patients who were monitored in the Chest Diseases Clinic of Akdeniz University Medical Faculty Hospital. Method: Between 01.01.2016 and 01.12.2021, 203 patients who were clinically and radiologically diagnosed with non-cystic fibrosis bronchiectasis at the Chest Disease Clinic of Akdeniz University Medical Faculty Hospital were included in the study. The data of the patients were scanned through the hospital information system. Sociodemographic data, etiologic factors, pulmonary function tests, radiologic findings, treatments, and laboratory results were recorded. The relationships of these factors with emergency department admission, outpatient clinic admission, hospitalization, and mortality were evaluated. Results: The mean age of the patients was 49.26±15.45 years (18-87). Of the patients, 109 (53.7%) were male and 94 (46.3%) were female. The most common etiologic cause was idiopathic bronchiectasis with 89 (43.3%) patients. The most common comorbid disease was asthma, with 54 (26.6%) patients. When sputum samples were analyzed, Pseudomonas aeruginosa was grown in 65 (32%) patients, Haemophilus influenza in 38 (18.7%) patients, and Streptococcus pneumoniae in 14 (6.9%) patients. 40 (19.7%) patients were colonized with Pseudomonas aeruginosa. The most commonly used parenteral antibiotic was sulbactam-ampicillin. The most commonly used oral antibiotics were amoxicillin-clavunate, clarithromycin, and fluoroquinolone group. There were 33 (16.2%) patients with COVID-19. There was no significant correlation between COVID-19 infection and age. The presence of comorbid COPD was associated with emergency department admission (p=0.004), hospitalization (p=0.042), higher bronchiectasis severity index (p=0.000), and higher mMRC dyspnea score (p=0.000). Emergency department admission was associated with inhaled tobramycin use (p=0.010), long-term oxygen therapy (p=0.003), non-invasive mechanical ventilator use (p=0.036), history of surgical resection for bronchiectasis (p=0. 004), low pulmonary function tests (FEV1, FVC, PEF) (p=0.000, p=0.000, p=0.000, p=0.000), high bronchiectasis severity index (p=0.000), Pseudomonas aeruginosa (p=0.001), Streptococcus pneumoniae (p=0.011), Klebsiella pneumoniae (p=0.040) growths. Polyclinic admission was significantly associated with the presence of cystic bronchiectasis (p=0.022), Pseudomonas aeruginosa growth (p=0.003), and colonization (p=0.001). Service admission was associated with the presence of COPD (p=0.007), history of nebulized tobramycin (p=0.000), USOT (p=0.000) and NIMV (p=0.036) use, surgery for bronchiectasis (p=0.000), low pulmonary function tests (FEV1, FVC, PEF) (p=0.000, p=0.000, p=0.000, p=0.000), presence of cystic bronchiectasis (p=0. 009), high bronchiectasis severity index (p=0.000), Pseudomonas aeruginosa growth in sputum (p=0.000) and colonization (p=0.000), Pneumococci (p=0.046), Moraxella catarrhalis (p=0.015) and Methicillin-resistant Staphylococcus aureus (p=0.042) growth in sputum. Regarding mortality, higher mMRC score (p=0.046) and lower PEF levels (p=0.049) increased the risk of mortality (OR=5.0, 95% CI [1.031-24.135], OR=1.2, 95% CI [0.998-1.000], respectively). In the study, the presence of secondary COPD was associated with a high mMRC dyspnea score (p=0.000). High bronchiectasis severity index level was associated with the presence of COPD (p=0.000), cystic bronchiectasis (p=0.010), and low body mass index (p=0.037). Pulmonary function tests (FEV1, FVC, PEF) were significantly lower in patients with cystic bronchiectasis than those without. Sputum cultures of patients with cystic bronchiectasis showed higher growth rates of Pseudomonas aeruginosa (p=0.005), Moraxella catarrhalis (p=0.047), and Klebsiella pneumoniae (p=0.026) compared to patients without cystic bronchiectasis. Conclusion: Hospital admissions and hospitalizations of bronchiectasis patients; COPD, use of inhaled tobramycin, USOT, NIMV, history of surgical resection for bronchiectasis, low pulmonary function tests (FEV1, FVC, PEF), Streptococcus pneumoniae in sputum culture, Klebsiella pneumoniae, Pseudomonas aeruginosa, Moraxella catarrhalis and Methicillin-resistant Staphylococcus aureus growths, high PEF levels, high mMRC levels and presence of cystic bronchiectasis were associated with mortality risk. High mMRC levels and low PEF values increased the mortality risk (OR=5.0, 95% CI [1.031-24.135], OR=1.2, 95% CI [0.998- 1.000], respectively).