Clinical outcomes of bronchiectasis in India: data from the EMBARC/Respiratory Research Network of India registry
Authors: Dhar Raja , Singh Sheetu , Talwar Deepak , Murali Mohan B.V. , Tripathi Surya Kant , Swarnakar Rajesh , Trivedi Sonali , Rajagopala Srinivas , D'Souza George , Padmanabhan Arjun , Archana B. , Mahesh P.A. , Ghewade Babaji , Nair Girija , Jindal Aditya , Jayadevappa Gayathri Devi H. , Sawhney Honney , Sarmah Kripesh Ranjan , Saha Kaushik , Anantharaj Suresh , Khanna Arjun , Gami Samir , Shah Arti , Shah Arpan , Dutt Naveen , Garg Himanshu , Vyas Sunil , Venugopal Kummannoor , Prasad Rajendra , Aleemuddin Naveed M. , Karmakar Saurabh , Singh Virendra , Jindal S.K. , Sharma Shubham , Prajapat Deepak , Chandrashekar Sagar , Loebinger Michael , Mishra Aditi , Blasi Francesco , Ramanathan Ramanathan Palaniappan , Goeminne Pieter C. , Vasudev Preethi , Shoemark Amelia , Jayaraj B.S. , Kungwani Rahul , Das Akanksha , Sawhney Mehneet , Polverino Eva , Welte Tobias , Gulecha Nayan Sri , Shteinberg Michal , Mangala Anshul , Shah Palak , Chauhan Nishant Kumar , Jajodia Nikita , Singhal Ashutosh , Batra Sakshi , Hasan Ashfaq , Aliberti Stefano , Crichton Megan L. , Limaye Sneha , Salvi Sundeep , Chalmers James D. ,   for the EMBARC-India study group
Published: October 2022

Background

Identifying risk factors for poor outcomes can help with risk stratification and targeting of treatment. Risk factors for mortality and exacerbations have been identified in bronchiectasis but have been almost exclusively studied in European and North American populations. This study investigated the risk factors for poor outcome in a large population of bronchiectasis patients enrolled in India.

Methods

The European Multicentre Bronchiectasis Audit and Research Collaboration (EMBARC) and Respiratory Research Network of India (EMBARC-India) registry is a prospective observational study of adults with computed tomography-confirmed bronchiectasis enrolled at 31 sites across India. Baseline characteristics of patients were used to investigate associations with key clinical outcomes: mortality, severe exacerbations requiring hospital admission, overall exacerbation frequency and decline in forced expiratory volume in 1 s.

Results

1018 patients with at least 12-month follow-up data were enrolled in the follow-up study. Frequent exacerbations (≥3 per year) at baseline were associated with an increased risk of mortality (hazard ratio (HR) 3.23, 95% CI 1.39–7.50), severe exacerbations (HR 2.71, 95% CI 1.92–3.83), future exacerbations (incidence rate ratio (IRR) 3.08, 95% CI 2.36–4.01) and lung function decline. Coexisting COPD, dyspnoea and current cigarette smoking were similarly associated with a worse outcome across all end-points studied. Additional predictors of mortality and severe exacerbations were increasing age and cardiovascular comorbidity. Infection with Gram-negative pathogens (predominantlyKlebsiella pneumoniae) was independently associated with increased mortality (HR 3.13, 95% CI 1.62–6.06), whilePseudomonas aeruginosainfection was associated with severe exacerbations (HR 1.41, 95% CI 1.01–1.97) and overall exacerbation rate (IRR 1.47, 95% CI 1.13–1.91).

Conclusions

This study identifies risk factors for morbidity and mortality among bronchiectasis patients in India. Identification of these risk factors may support treatment approaches optimised to an Asian setting.