Prognostic implications of cluster-defined phenotypes in AECOPD patients with bronchiectasis: A multicenter study

The clinical impact of bronchiectasis (BE) in acute exacerbations of COPD (AECOPD) remains controversial, with unclear phenotypic heterogeneity.

Does BE independently influence clinical outcomes and phenotypic heterogeneity in AECOPD patients?

This prospective multicenter cohort study analysed 11 759 hospitalised AECOPD patients from 10 Chinese medical centres. Propensity score matching (1:3) balanced baseline characteristics, and unsupervised cluster analysis identified phenotypic subgroups. Primary endpoints included mortality and exacerbation frequency, with secondary endpoints assessing mechanical ventilation, ICU admission, and length of stay (LOS).

AECOPD-BE patients had higher rates of non-invasive ventilation (23.5% vs 20.1%, p = 0.002), ICU admission (9.8% vs 6.5%, p < 0.001), and prolonged LOS (median 10 vs 9 days, p < 0.001). Mortality rates were similar (in-hospital: 1.1% vs 1.3%, p = 0.477; 3-year: 17.8% vs 21.6%, p = 0.652), but BE patients had more exacerbations (2.92 ± 4.30 vs 2.18 ± 2.72 events, p = 0.004). Cluster analysis revealed two phenotypes: a Systemic Inflammatory-High Risk (SI-HR) subgroup with severe inflammation and poorer outcomes, and a Stable Compensated (SC) subgroup with milder manifestations.

BE independently predicts increased acute healthcare utilisation and exacerbation risk in AECOPD without affecting mortality. The SI-HR phenotype identification supports targeted management strategies for this heterogeneous population.Clinical Trial Registration: Chinese Clinical Trail Registry NO.: ChiCTR2100044625; URL: http://www.chictr.org.cn/showproj.aspx?proj=121626.