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Prognostic implications of cluster-defined phenotypes in AECOPD patients with bronchiectasis: A multicenter study
Jiaqi Pu1,2, Yuanming Luo3, Hailong Wei4
1Department of Respiratory and Critical Care Medicine, West China Hospital, Sichuan University, Chengdu, Sichuan Province, China.
Pulmonology
|November 24, 2025
Summary
Bronchiectasis (BE) in acute exacerbations of COPD (AECOPD) increases healthcare use and exacerbation risk but not mortality. Identifying phenotypes like Systemic Inflammatory-High Risk (SI-HR) aids targeted management.
Area of Science:
- Pulmonology
- Clinical Medicine
- Epidemiology
Background:
- The clinical significance of bronchiectasis (BE) in acute exacerbations of COPD (AECOPD) is debated.
- Phenotypic heterogeneity in AECOPD patients with BE is not well understood.
Purpose of the Study:
- To investigate whether BE independently impacts clinical outcomes and phenotypic heterogeneity in AECOPD patients.
- To identify distinct phenotypes within the AECOPD population, particularly concerning the presence of BE.
Main Methods:
- A prospective multicenter cohort study of 11,759 hospitalized AECOPD patients.
- Propensity score matching (1:3) to balance baseline characteristics.
- Unsupervised cluster analysis to identify phenotypic subgroups.
Main Results:
- AECOPD patients with BE showed higher rates of non-invasive ventilation, ICU admission, and prolonged length of stay.
- Mortality rates were similar, but BE patients experienced more exacerbations.
- Cluster analysis identified two phenotypes: Systemic Inflammatory-High Risk (SI-HR) and Stable Compensated (SC).
Conclusions:
- Bronchiectasis independently predicts increased acute healthcare utilization and exacerbation risk in AECOPD.
- BE does not appear to affect mortality in AECOPD patients.
- Identification of the SI-HR phenotype supports tailored management strategies for heterogeneous AECOPD populations.
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