FACTORS AFFECTING MORTALITY AND MORBIDITY IN PATIENTS WITH BRONCHIECTASIS

Yıl 2019, Cilt: 20 Sayı: 2, 83 - 90, 29.04.2019

Berna Akıncı Özyürek Şerife Savaş Bozbaş Eylül Bozkurt Yılmaz Gaye Ulubay Şule Akçay Füsun Öner Eyüboğlu

https://doi.org/10.18229/kocatepetip.422758

Öz

OBJECTIVE: Recurrent bronchial infections lead to a decrease in pulmonary function and an increase in mortality and morbidity in patients with bronchiectasis. We aimed to evaluate mortality rate and identify risk factors in mortality in patients with bronchiectasis.

MATERIAL AND METHODS: In this study the records of 104 patients who underwent high resolution computed tomography (HRCT) were evaluated. Demographic variables, symptoms, physical examination findings, HRCT and pulmonary function test (PFT), culture and sputum analysis results, antibiotic resistance, infection markers, need to stay in intensive care unit and mortality rates were examined.

RESULTS: The mean age was 59.5±15.1 years. Sputum production was detected in 65.4% of the cases and in 27.9% a microorganism was identified on sputum culture. Antibiotic resistance was detected in 11.5% of the cases. Infection episode, antibiotic resistance, age, smoking and respiratory insufficiency were associated with mortality (p<0.05 for all). A significant difference was noted in FEV1% between patients with and without antibiotic resistance (p<0.05). There was negative association between FEV1 and antibiotic resistance (r=-0.257, p=0.02), respiratory insufficiency (r=-0.288, p=0.01) and infection episodes (r=-0.329, p=0.003). Number of infection episode was higher in patients with a FEV1 <60% (p=0.003). Pulmonary hypertension was detected in 21.2% of the patients which was significantly more common in tubular and bilateral bronchiectasis.

CONCLUSIONS: Older age, smoking, infection episode, respiratory insufficiency and antibiotic resistance were associated with an increased risk of mortality. Our findings indicate that antibiotic resistance should be determined in patients with bronchiectasis who have a FEV1 value <60% as these cases have increased mortality.

Anahtar Kelimeler

Bronchiectasis, infection, mortality, pulmonary function

Bronşiektazili Hastalarda Mortalite ve Morbiditeyi Etkileyen Faktörler

Öz

AMAÇ: Bronşektazide tekrarlayan bronş enfeksiyonları; akciğer fonksiyonlarında azalma, mortalite ve morbiditede artışa yol açar. Çalışmamızda bronşektazide mortalite oranlarını ve mortaliteye yol açan risk faktörlerini değerlendirmeyi amaçladık.

GEREÇ VE YÖNTEM: Çalışmaya yüksek rezolüsyonlu bilgisayarlı tomografisi (YRBT) olan 104 hasta dahil edildi. Demografik özellikleri, semptomları, fizik muayene bulguları, YRBT bulguları, solunum fonksiyon testleri, balgam analizleri ve kültür sonuçları, antibiyotik dirençleri, infeksiyon parametreleri, yoğun bakım ihtiyaçları ve mortalite oranları retrospektif olarak değerlendirildi.

BULGULAR: Ortalama yaş 59.5±15.1 idi. Hastaların % 65.4’ünün balgam şikayeti vardı, % 27.9’unda balgam kültüründe mikroorganizma saptandı. % 11.5 olguda antibiyotik direnci saptandı. Enfeksiyon sıklığı, antibiyotik direnci; yaş, sigara ve solunum yetmezliği mortalite ile ilişkili bulundu (p<0.05). Antibiyotik direnci olan ve olmayan hastalar arasında FEV1%’de farklılık saptandı (p<0.05). FEV1 ile antibiyotik direnci (r=-0.257, p=0.02), solunum yetmezliği (r=-0.288, p=0.01) ve infeksiyon sıklığı (r=-0.329, p=0.003) arasında negatif ilişki saptandı. Sık enfeksiyon geçirenlerde FEV1 < % 60 olarak ölçüldü (p=0.003). Pulmoner hipertansiyon daha yaygın olarak tübüler ve bilateral bronşektazisi olan hastalarda bulundu (% 21.2).

SONUÇ: Bronşektazide ileri yaş, sigara içimi, enfeksiyon sıklığı, solunum yetmezliği ve antibiyotik direnci mortalite riskinin artması ile ilişkilidir. Çalışmamızda antibiyotik direnci saptanan hastalarda FEV1 < % 60 olarak bulunmasının mortaliteyi artırdığını saptadık.

Anahtar Kelimeler

Bronşiektazi, infeksiyon, mortalite

Kaynakça

• 1. Martínez-García MA, Soler-Cataluña JJ, Perpiñá-Tordera M, Román-Sánchez P, Soriano J. Factors associated with lung function decline in adult patients with stable non-cystic fibrosis bronchiectasis. Chest. 2007;132:1565-72.
• 2. McGuinness G, Naidich DP, Leitman BS, McCauley DI. Bronchiectasis: CT evaluation. AJR Am J Roentgenol. 1993;160:253-9.
• 3. Naidich DP, McCauley DI, Khouri NF, Stitik FP, Siegelman SS. Computed tomography of bronchiectasis. J Comput Assist Tomogr. 1982;6:437-44.
• 4. Miller MR, Crapo R, Hankinson J, Brusasco V, Burgos F, Casaburi R, Coates A, Enright P, van der Grinten CP, Gustafsson P, Jensen R, Johnson DC, MacIntyre N, McKay R, Navajas D, Pedersen OF, Pellegrino R, Viegi G, Wanger J; ATS/ERS Task Force. General considerations for lung function testing. Eur Respir J. 2005;26:153-61.
• 5. Berger M, Haimowitz A, Van Tosh A, Berdoff RL, Goldberg E. Quantitative assessment of pulmonary hypertension in patients with tricuspid regurgitation using continuous wave Doppler ultrasound. J Am Coll Cardiol. 1985;6:359-65.
• 6. Barker AF. Bronchiectasis. N Engl J Med. 2002;246:1383–93.
• 7. Wong-You-Cheong JJ, Leahy BC, Taylor PM, Church SE. Airways obstruction and bronchiectasis: Correlation with duration of symptoms and extent of bronchiectasis on computed tomography. Clinical Radiology. 1992;45:256-9.
• 8. Loubeyre P, Paret M, Revel D, Wiesendanger T, Brune J. Thin section CT detection of emphysema associated with bronchiectasis and correlation with pulmonary function test. Chest. 1996;109;2:360-5.
• 9. Grenier P, Mourey-Gerosa I, Benali K, Brauner MW, Leung AN, Lenoir S, Cordeau MP, Mazoyer B. Abnormalities of the airways and lung parenchyma in asthmatics: CT observations in 50 patients and inter- and intra-observer variability. Eur Radiol. 1996;6:199–206.
• 10. Martinez-Garcia MA, Perpin˜a´ -Tordera M, Roma´n-Sanchez P, Soler-Catalun˜a JJ. Inhaled steroids improve quality of life in patients with steady-state bronchiectasis. Resp Med. 2006;100:1623–32.
• 11. Tsang KW, Ho PL, Lam WK, Ip MS, Chan KN, Ho CS, Ooi CC, Yuen KY. Inhaled fluticasone reduces sputum inflammatory indices in severe bronchiectasis. Am J Respir Crit Care Med. 1998;158:723-7.
• 12. Tsang KW, Tan KC, Ho PL, Ooi GC, Ho JC, Mak J, Tipoe GL, Ko C, Yan C, Lam WK, Chan-Yeung M. Inhaled fluticasone in bronchiectasis: a 12 month study. Thorax. 2005;60:239-43.
• 13. Angrill J, Agustí C, de Celis R, Rañó A, Gonzalez J, Solé T, Xaubet A, Rodriguez-Roisin R, Torres A. Bacterial colonisation in patients with bronchiectasis: microbiological pattern and risk factors. Thorax. 2002;57:15-9.
• 14. Tunney MM, Einarsson GG, Wei L, Drain M, Klem ER, Cardwell C, et al. Lung microbiota and bacterial abundance in patients with bronchiectasis when clinically stable and during exacerbation. Am J Respir Crit Care Med 2013;187:1118-26.
• 15. Guan WJ, Gao YH, Xu G, Lin ZY, Tang Y, Li HM, Lin ZM, Zheng JP, Chen RC, Zhong NS.Sputum bacteriology in steady-state bronchiectasis in Guangzhou, China. Int J Tuberc Lung Dis. 2015 May;19(5):610-9. doi: 10.5588/ijtld.14.0613.
• 16. King PT, Holdsworth SR, Freezer NJ, Villanueva E, Holmes PW. Microbiologic follow-up study in adult bronchiectasis. Respir Med. 2007;101:1633-8.
• 17. Evans SA, Turner SM, Bosch BJ, Hardy CC, Woodhead MA. Lung function in bronchiectasis: the influence of Pseudomonas aeruginosa. Eur Respir J. 1996;9:1601-4.
• 18. Celli BR, MacNee W. Standards for the diagnosis and treatment of patients with COPD: a summary of the ATS/ERS position paper. ATS/ERS Task Force. Eur Respir J. 2004;23:932-46.
• 19. Peinado VI, Barberá JA, Abate P, Ramírez J, Roca J, Santos S, Rodriguez-Roisin R. Inflammatory reaction in pulmonary muscular arteries of patients with mild chronic obstructive pulmonary disease. Am J Respir Crit Care Med. 1999;159:1605-11.
• 20. Yonghua Chen, Chunli Liu, Wenju Lu, Mengxi Li, Cyrus Hadadi, Elizabeth Wenqian Wang,Kai Yang, Ning Lai, Junyi Huang,Shiyue Li, Nanshan Zhong,Nuofu Zhang, and Jian Wang. Clinical characteristics and risk factors of pulmonary hypertension associated with chronic respiratory diseases: a retrospective study. J Thorac Dis. 2016 Mar; 8(3): 350–358. doi: 10.21037/jtd.2016.02.58
• 21. Alzeer AH, Al-Mobeirek AF, Al-Otair HA, Elzamzamy UA, Joherjy IA, Shaffi AS. Right and left ventricular function and pulmonary artery pressure in patients with bronchiectasis.Chest. 2008;133:468-73.
• 22. Keistinen T, Säynäjäkangas O, Tuuponen T, Kivelä SL. Bronchiectasis: an orphan disease with a poorly-understood prognosis. Eur Respir J. 1997;10:2784-7.
• 23. Finklea JD, Khan G, Thomas S, Song J, Myers D, Arroliga AC. Predictors of mortality in hospitalized patients with acute exacerbation of bronchiectasis. Respir Med. 2010;104:816-21.
• 24. Loebinger MR, Wells AU, Hansell DM, Chinyanganya N, Devaraj A, Meister M, Wilson R. Mortality in bronchiectasis: a long-term study assessing the factors influencing survival. Eur Respir J. 2009;34:843-9.
• 25. Chalmers JD, Goeminne P, Aliberti S, McDonnell MJ, Lonni S, Davidson J, Poppelwell L, Salih W, Pesci A, Dupont LJ, Fardon TC, Soyza AD, Hill AT. The Bronchiectasis Severity İndex: An İnternational Derivation And Validation Study. Am J Respir Crit Care Med 2014; 189: 576-585.
• 26. Wilson CB, Jones PW, O'Leary CJ, Hansell DM, Dowling RB, Cole PJ, Wilson R. Systemic markers of inflammation in stable bronchiectasis. Eur Respir J. 1998;12:820–4.
• 27. Puren AJ, Feldman C, Savage N, Becker PJ, Smith C. Patterns of cytokine expression in community-acquired pneumonia. Chest. 1995;107:1342–9.