Miguel Á Martínez-García1, Montserrat Vendrell2,3, Rosa Girón4, Luis Máiz-Carro5, David de la Rosa Carrillo6, Javier de Gracia3,7, Casilda Olveira8. 1. 1 Pneumology Department, Polytechnic and University La Fe Hospital, Valencia, Spain. 2. 2 Bronchiectasis Group, Girona Biomedical Research Institute (IDIBGI), Doctor Trueta University Hospital, Girona, Spain. 3. 3 Biomedical Research Networking Center (CIBER) of Respiratory Diseases (Ciberes CB06/06/0030), Carlos III Health Institute, Madrid, Spain. 4. 4 Pneumology Service, Hospital La Princesa, Madrid, Spain. 5. 5 Pneumology Service, Hospital Ramón y Cajal, Madrid, Spain. 6. 6 Pneumology Unit, Hospital Platón, Barcelona, Spain. 7. 7 Pneumology Service, Hospital Universitari Vall d'Hebron Barcelona, Spain; and. 8. 8 Pneumology, Malaga Regional University Hospital, Instituto de Biomedicina de Málaga (IBIMA), Málaga University, Spain.
Abstract
RATIONALE: The clinical presentation and prognosis of non-cystic fibrosis bronchiectasis are both very heterogeneous. OBJECTIVES: To identify different clinical phenotypes for non-cystic fibrosis bronchiectasis and their impact on prognosis. METHODS: Using a standardized protocol, we conducted a multicenter observational cohort study at six Spanish centers with patients diagnosed with non-cystic fibrosis bronchiectasis before December 31, 2005, with a 5-year follow-up from the bronchiectasis diagnosis. A cluster analysis was used to classify the patients into homogeneous groups by means of significant variables corresponding to different aspects of bronchiectasis (clinical phenotypes): age, sex, body mass index, smoking habit, dyspnea, macroscopic appearance of sputum, number of exacerbations, chronic colonization with Pseudomonas aeruginosa, FEV1, number of pulmonary lobes affected, idiopathic bronchiectasis, and associated chronic obstructive pulmonary disease. Survival analysis (Kaplan-Meier method and log-rank test) was used to evaluate the comparative survival of the different subgroups. MEASUREMENTS AND MAIN RESULTS: A total of 468 patients with a mean age of 63 (15.9) years were analyzed. Of these, 58% were females, 39.7% had idiopathic bronchiectasis, and 29.3% presented with chronic Pseudomonas aeruginosa colonization. Cluster analysis showed four clinical phenotypes: (1) younger women with mild disease, (2) older women with mild disease, (3) older patients with severe disease who had frequent exacerbations, and (4) older patients with severe disease who did not have frequent exacerbations. The follow-up period was 54 months, during which there were 95 deaths. Mortality was low in the first and second groups (3.9% and 7.6%, respectively) and high for the third (37%) and fourth (40.8%) groups. The third cluster had a higher proportion of respiratory deaths than the fourth (77.8% vs. 34.4%; P < 0.001). CONCLUSIONS: Using cluster analysis, it is possible to separate patients with bronchiectasis into distinct clinical phenotypes with different prognoses.
RATIONALE: The clinical presentation and prognosis of non-cystic fibrosis bronchiectasis are both very heterogeneous. OBJECTIVES: To identify different clinical phenotypes for non-cystic fibrosis bronchiectasis and their impact on prognosis. METHODS: Using a standardized protocol, we conducted a multicenter observational cohort study at six Spanish centers with patients diagnosed with non-cystic fibrosis bronchiectasis before December 31, 2005, with a 5-year follow-up from the bronchiectasis diagnosis. A cluster analysis was used to classify the patients into homogeneous groups by means of significant variables corresponding to different aspects of bronchiectasis (clinical phenotypes): age, sex, body mass index, smoking habit, dyspnea, macroscopic appearance of sputum, number of exacerbations, chronic colonization with Pseudomonas aeruginosa, FEV1, number of pulmonary lobes affected, idiopathic bronchiectasis, and associated chronic obstructive pulmonary disease. Survival analysis (Kaplan-Meier method and log-rank test) was used to evaluate the comparative survival of the different subgroups. MEASUREMENTS AND MAIN RESULTS: A total of 468 patients with a mean age of 63 (15.9) years were analyzed. Of these, 58% were females, 39.7% had idiopathic bronchiectasis, and 29.3% presented with chronic Pseudomonas aeruginosa colonization. Cluster analysis showed four clinical phenotypes: (1) younger women with mild disease, (2) older women with mild disease, (3) older patients with severe disease who had frequent exacerbations, and (4) older patients with severe disease who did not have frequent exacerbations. The follow-up period was 54 months, during which there were 95 deaths. Mortality was low in the first and second groups (3.9% and 7.6%, respectively) and high for the third (37%) and fourth (40.8%) groups. The third cluster had a higher proportion of respiratory deaths than the fourth (77.8% vs. 34.4%; P < 0.001). CONCLUSIONS: Using cluster analysis, it is possible to separate patients with bronchiectasis into distinct clinical phenotypes with different prognoses.
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Authors: M A Martinez-Garcia; R A Athanazio; R Girón; L Máiz-Carro; D de la Rosa; C Olveira; J de Gracia; M Vendrell; C Prados-Sánchez; G Gramblicka; M Corso Pereira; F L Lundgren; M Fernandes De Figueiredo; F Arancibia; S Z Rached Journal: Int J Chron Obstruct Pulmon Dis Date: 2017-01-18
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Authors: Andrea Gramegna; Stefano Aliberti; Manuela Seia; Luigi Porcaro; Vera Bianchi; Carlo Castellani; Paola Melotti; Claudio Sorio; Enza Consalvo; Elisa Franceschi; Francesco Amati; Martina Contarini; Michele Gaffuri; Luca Roncoroni; Barbara Vigone; Angela Bellofiore; Cesare Del Monaco; Martina Oriano; Leonardo Terranova; Maria Francesca Patria; Paola Marchisio; Baroukh M Assael; Francesco Blasi Journal: Multidiscip Respir Med Date: 2018-08-09