FACTORS AFFECTING MORTALITY AND MORBIDITY IN PATIENTS WITH BRONCHIECTASIS

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

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