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Bronchiectasis complicated by pulmonary aspergillosis: a multicenter study on prognosis and risk factors
Jie Yang1,2, Xinyu Wang3, Shuai Lu4
1Department of Respiratory and Critical Care Medicine, Jinling Hospital, The First School of Clinical Medicine, Southern Medical University, Nanjing, China.
Background:
Aspergillus-related pulmonary diseases are frequent in bronchiectasis patients due to the impaired mucociliary clearance. However, research on the characteristics and factors of aspergillosis in patients with bronchiectasis is limited. The study aims to assess the prevalence and characteristics of pulmonary aspergillosis (PA) in patients with bronchiectasis, and identify potential factors linked to aspergillosis complications.
Methods:
We reviewed the medical records of 899 bronchiectasis patients from four tertiary hospitals. We identified 62 patients who were diagnosed with PA, encompassing 11 cases of invasive PA (IPA) and 51 cases of chronic PA (CPA). They were compared with 241 controls without aspergillosis.
Results:
Bronchiectasis patients with PA exhibited a significantly higher frequency of exacerbations (P=0.001) and hospitalizations (P=0.001) in the preceding year compared to those without PA. Chest high-resolution computed tomography (HRCT) scans revealed that patients with PA exhibited a greater prevalence of consolidation/infiltrates, cavities, nodular shadows, and pleural thickening. Moreover, a higher proportion of patients in the PA group had undergone lobectomy (11.3% vs. 0%). The in-hospital mortality rate was also higher in the PA group (4.8% vs. 0.4%). In terms of post-discharge outcomes, the PA group had more hospitalizations at both the 6- and 12-month follow-up, and patients with PA had a higher 1-year mortality rate after discharge (11.3% vs. 3.5%). Multivariate analysis identified the presence of cavities on chest HRCT and a previous history of pulmonary tuberculosis (TB) as independent risk factors for the development of PA.
Conclusions:
PA is frequent in bronchiectasis and associated with a poorer prognosis. Cavities on HRCT and prior pulmonary TB are significant risk factors for PA in these patients.
Insights
Pulmonary aspergillosis (PA) is common in bronchiectasis patients and linked to worse outcomes. Identifying cavities on HRCT scans and a history of pulmonary tuberculosis are key risk factors for developing PA.
Area of Science:
- Pulmonology
- Infectious Diseases
- Radiology
Background:
- Aspergillus-related pulmonary diseases are common in bronchiectasis patients due to impaired mucociliary clearance.
- Limited research exists on the characteristics and contributing factors of aspergillosis in this patient population.
- This study investigates pulmonary aspergillosis (PA) in bronchiectasis patients.
Purpose of the Study:
- To assess the prevalence and characteristics of PA in bronchiectasis patients.
- To identify factors associated with aspergillosis complications in bronchiectasis.
- To evaluate the prognosis and mortality associated with PA in bronchiectasis.
Main Methods:
- Retrospective review of medical records from 899 bronchiectasis patients across four tertiary hospitals.
- Identification of 62 patients diagnosed with PA (11 invasive, 51 chronic) and comparison with 241 controls without aspergillosis.
- Analysis of clinical data, chest HRCT findings, and patient outcomes including exacerbations, hospitalizations, and mortality.
Main Results:
- PA patients had significantly more exacerbations and hospitalizations in the prior year.
- Chest HRCT revealed higher prevalence of consolidation, cavities, nodular shadows, and pleural thickening in PA patients.
- PA was associated with higher in-hospital and 1-year post-discharge mortality rates.
Conclusions:
- Pulmonary aspergillosis is frequent in bronchiectasis patients and associated with a poorer prognosis.
- Presence of cavities on chest HRCT and a history of pulmonary tuberculosis are significant independent risk factors for PA in bronchiectasis.
- Early identification and management of PA in bronchiectasis patients are crucial for improving outcomes.
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