Comparison of Clinical Characteristics and Short-Term Prognoses Within Hospitalized Chronic Obstructive Pulmonary Disease Patients Comorbid With Asthma, Bronchiectasis, and Their Overlaps: Findings From the ACURE Registry

Abstract

Introduction: Real-world evidence and comparison among commonly seen chronic obstructive pulmonary disease (COPD) phenotypes, i.e., asthma-COPD overlap (ACO), bronchiectasis-COPD overlap (BCO), and their coexistence (ABCO) have not been fully depicted, especially in Chinese patients.

Methods: Data were retrieved from an ongoing nationwide registry in hospitalized patients due to acute exacerbation of COPD in China (ACURE).

Results: Of the eligible 4,813 patients with COPD, 338 (7.02%), 492 (10.22%), and 63 (1.31%) were identified as ACO, BCO, and ABCO phenotypes, respectively. Relatively, the ABCO phenotype had a younger age with a median of 62.99 years [interquartile range (IQR): 55.93-69.48] and the COPD phenotype had an older age with a median of 70.15 years (IQR: 64.37-76.82). The BCO and COPD phenotypes were similar in body mass index with a median of 21.79 kg/m² (IQR: 19.47-23.97) and 21.79 kg/m² (IQR: 19.49-24.22), respectively. The COPD phenotype had more male gender (79.90%) and smokers (71.12%) with a longer history of smoking (median: 32.45 years, IQR: 0.00-43.91). The ACO and ABCO phenotypes suffered more prior allergic episodes with a proportion of 18.05 and 19.05%, respectively. The ACO phenotype exhibited a higher level of eosinophil and better lung reversibility. Moreover, the four phenotypes showed no significant difference neither in all-cause mortality, intensive care unit admission, length of hospital stay, and COPD Assessment Test score change during the index hospitalization, and nor in the day 30 outcomes, i.e., all-cause mortality, recurrence of exacerbation, all-cause, and exacerbation-related readmission.

Conclusions: The ACO, BCO, ABCO, and COPD phenotypes exhibited distinct clinical features but had no varied short-term prognoses. Further validation in a larger sample is warranted.

Keywords: asthma; bronchiectasis; chronic obstructive pulmonary disease; exacerbation; heterogeneity; phenotype; prognosis.

Figure 1

Flowchart of diagram in current analyses. ABCO, chronic obstructive pulmonary disease patients comorbid with asthma and bronchiectasis; ACO, asthma-chronic obstructive pulmonary disease overlap; ACURE, the acute exacerbation of chronic obstructive pulmonary disease inpatient registry; AECOPD, acute exacerbation of chronic obstructive pulmonary disease; BCO, bronchiectasis- chronic obstructive pulmonary disease overlap; CT, computed tomography.

Figure 2

(A) Independent risk factors associated with length of index hospital stay. (B) Independent risk factors associated with recurrence of AECOPD within 30 days after the index hospital discharge. (C) Independent risk factors associated with exacerbation-related hospital readmission within 30 days after the index hospital discharge. ABCO, chronic obstructive pulmonary disease patients comorbid with asthma and bronchiectasis; ACO, asthma-chronic obstructive pulmonary disease overlap; AECOPD, acute exacerbation of chronic obstructive pulmonary disease; BCO, bronchiectasis-chronic obstructive pulmonary disease overlap; BMI, body mass index; CI, confidence interval; DVT, deep venous thrombosis; HR, hazard ratio; ICU, intensive care unit; PE, pulmonary embolism; RICU, respiratory intensive care unit.

Figure 3

(A) Kaplan–Meier curve and log-rank test for day 30 outcomes between ACO and BCO phenotypes in hospitalized patients with AECOPD. Kaplan–Meier curve and log-rank test for day 30 outcomes (a) recurrent exacerbation (P = 0.2137) and (b) exacerbation-related readmission (p = 0.2571) between ACO and BCO phenotypes in hospitalized patients with AECOPD. (B) Kaplan–Meier curve and log-rank test for day 30 outcomes between ACO phenotype and patients without asthma or bronchiectasis in hospitalized patients with AECOPD. Kaplan–Meier curve and log-rank test for day 30 outcomes (a) recurrent exacerbation (p = 0.4103) and (b) exacerbation-related readmission (p = 0.4777) between ACO phenotype and patients without asthma or bronchiectasis in hospitalized patients with AECOPD. (C) Kaplan–Meier curve and log-rank test for day 30 outcomes between BCO phenotype and patients without asthma or bronchiectasis in hospitalized patients with AECOPD. Kaplan–Meier curve and log-rank test for day 30 outcomes (a) recurrent exacerbation (P = 0.3707) and (b) exacerbation-related readmission (P = 0.3768) between BCO phenotype and patients without asthma or bronchiectasis in hospitalized patients with AECOPD. (D) Kaplan–Meier curve and log-rank test for day 30 outcomes among four phenotypes in hospitalized patients with AECOPD. Kaplan–Meier curve and log-rank test for day 30 outcomes (a) recurrent exacerbation (P = 0.5174) and (b) exacerbation-related readmission (P = 0.6853) among four phenotypes in hospitalized patients with AECOPD. ABCO, chronic obstructive pulmonary disease patients comorbid with asthma and bronchiectasis; ACO, asthma-chronic obstructive pulmonary disease overlap; AECOPD, acute exacerbation of chronic obstructive pulmonary disease; BCO, bronchiectasis-chronic obstructive pulmonary disease overlap; COPD, chronic obstructive pulmonary disease.