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Observational Study
. 2023 Jan 6;61(1):2200611.
doi: 10.1183/13993003.00611-2022. Print 2023 Jan.

Clinical outcomes of bronchiectasis in India: data from the EMBARC/Respiratory Research Network of India registry

Raja Dhar  1 , Sheetu Singh  2 , Deepak Talwar  3 , B V Murali Mohan  4 , Surya Kant Tripathi  5 , Rajesh Swarnakar  6 , Sonali Trivedi  7 , Srinivas Rajagopala  8 , George D'Souza  9 , Arjun Padmanabhan  10 , B Archana  11 , P A Mahesh  12 , Babaji Ghewade  13 , Girija Nair  14 , Aditya Jindal  15 , Gayathri Devi H Jayadevappa  16 , Honney Sawhney  17 , Kripesh Ranjan Sarmah  18 , Kaushik Saha  19 , Suresh Anantharaj  20 , Arjun Khanna  21 , Samir Gami  22 , Arti Shah  23 , Arpan Shah  24 , Naveen Dutt  25 , Himanshu Garg  26 , Sunil Vyas  27 , Kummannoor Venugopal  28 , Rajendra Prasad  29 , Naveed M Aleemuddin  30 , Saurabh Karmakar  31 , Virendra Singh  32 , S K Jindal  15 , Shubham Sharma  1 , Deepak Prajapat  3 , Sagar Chandrashekar  4 , Michael Loebinger  33 , Aditi Mishra  6 , Francesco Blasi  34 , Ramanathan Palaniappan Ramanathan  8 , Pieter C Goeminne  35 , Preethi Vasudev  10 , Amelia Shoemark  36 , B S Jayaraj  12 , Rahul Kungwani  13 , Akanksha Das  14 , Mehneet Sawhney  17 , Eva Polverino  37 , Tobias Welte  38 , Nayan Sri Gulecha  20 , Michal Shteinberg  39 , Anshul Mangala  23 , Palak Shah  24 , Nishant Kumar Chauhan  25 , Nikita Jajodia  26 , Ashutosh Singhal  27 , Sakshi Batra  29 , Ashfaq Hasan  30 , Stefano Aliberti  40 , Megan L Crichton  36 , Sneha Limaye  41 , Sundeep Salvi  41 , James D Chalmers  42 ; EMBARC-India study group
Affiliations
Observational Study

Clinical outcomes of bronchiectasis in India: data from the EMBARC/Respiratory Research Network of India registry

Raja Dhar et al. Eur Respir J. .

Abstract

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 (predominantly Klebsiella pneumoniae) was independently associated with increased mortality (HR 3.13, 95% CI 1.62-6.06), while Pseudomonas aeruginosa infection 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.

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Conflict of interest statement

Conflict of interest: M. Loebinger reports grants from AstraZeneca, Insmed and Grifols, outside the submitted work. F. Blasi reports grants from AstraZeneca, Bayer, Chiesi, GlaxoSmithKline, Menarini and Pfizer; consulting fees from Novartis, Pfizer, Zambon, Vertex, Viatris, AstraZeneca, Bayer, Chiesi, GlaxoSmithKline, Grifols, Guidotti, Insmed and Menarini, outside the submitted work. A. Shoemark reports grants from AstraZeneca, outside the submitted work. E. Polverino reports grants from Chiesi, Zambon, Shionogi, Teva, CSL Boehring, Insmed and Grifols, outside the submitted work. T. Welte reports grants from AstraZeneca and GlaxoSmithKline, outside the submitted work. M. Shteinberg reports grants from Trudell, GlaxoSmithKline, Novartis, Boehringer Ingelheim, AstraZeneca, Kamada, Vertex, Teva, Actelion and Rafa, outside the submitted work. S. Aliberti reports grants from Insmed, Chiesi and Fisher & Paykel; consulting fees from McGraw Hill, Insmed, Zambon, AstraZeneca, CSL Behring, Grifols, Fondazione Charta, Boehringer Ingelheim, Chiesi, Zcube, Menarini and GlaxoSmithKline, outside the submitted work. S. Limaye reports grants from Glenmark, supporting the present manuscript. J.D. Chalmers reports grants from AstraZeneca, Novartis, Boehringer Ingelheim, Insmed, GlaxoSmithKline and Gilead Sciences; consulting fees from AstraZeneca, Insmed, Boehringer Ingelheim, Janssen, Chiesi, Novartis, GlaxoSmithKline, Pfizer and Zambon, outside the submitted work. All other authors have nothing to disclose.

Figures

FIGURE 1
FIGURE 1
Performance of severity assessment tools (Bronchiectasis Severity Index (BSI) and FACED) for predicting clinical outcomes. a, b) Cox proportional hazards regression. Each panel displays the hazard ratios for a) mortality and b) severe exacerbations for moderate and severe patients compared with the mild group. c, d) Receiver operator characteristic curves for predicting c) mortality and d) severe exacerbations compared with the reference line (area under the curve 0.5).
See this image and copyright information in PMC

Comment in

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