Cardiovascular events after acute exacerbation of bronchiectasis_Chinese Journal of Respiratory and Critical Care Medicine

Authors：

 ZHANG Yuancheng

Department of Respiratory and Critical Care Medicine, Nanyang First People's Hospital, Nanyang, Henan 473000, P. R. China;

Corresponding?author：

ZHANG Yuancheng, Email: Z66yuan99cheng@126.com

Keywords：

Bronchiectasis; cardiovascular events; acute exacerbation; prognosis

DOI：

10.7507/1671-6205.202307029

Video：

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Objective To investigate the cardiovascular events (CVE) and survival status of patients with bronchiectasis (BE) during follow-up after acute exacerbation. Methods Prospective cohort study was used. Clinical data of 134 BE patients with acute exacerbation who were hospitalized from July 2016 to September 2020 were collected. The patients were followed up after discharge by phone or respiratory clinic every 3 months until November 2022. CVE or death was the endpoint event. Result During the follow-up period, 41 patients developed CVE, while 93 patients did not. Fifty-one patients died during the follow-up period, with a mortality rate of 38.06%. Among them, 41 cases of CVE resulted in 21 deaths, with a mortality rate of 51.22%; 30 cases died in 93 non-CVE patients, with a mortality rate of 32.26%. Logistic regression results showed significant influencing factors for CVE in BE patients were age, hypertension, chronic obstructive pulmonary disease (COPD), and moderate to severe illness. The significant influencing factors for the death of BE patients were age, COPD, moderate and severe illness, and CVE events. The significant influencing factors for the death of CVE patients were age and receiving CVE treatment. The area under ROC curve (AUC) and 95%CI was 0.858 (0.729 - 0.970) for the warning model for CVE in BE patients. The AUC (95%CI) was 0.867 (0.800 - 0.927) for the warning model for death in BE patients. The AUC (95%CI) was 0.811 (0.640 - 0.976) for the warning model for death of CVE patients. Conclusions Population factors and comorbidities are risk factors for CVE in BE patients after acute exacerbation. The appearance of CVE worsens the long-term prognosis of BE patients. The corresponding warning models have high warning effectiveness with AUC>0.8.

Citation： ZHANG Yuancheng. Cardiovascular events after acute exacerbation of bronchiectasis. Chinese Journal of Respiratory and Critical Care Medicine, 2023, 22(9): 634-639. doi: 10.7507/1671-6205.202307029 Copy

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2.	Lee SC, Son KJ, Han CH, et al. Cardiovascular and cerebrovascular-associated mortality in patients with preceding bronchiectasis exacerbation. Ther Adv Respir Dis, 2022, 16: 17534666221144206.
3.	Chen S, Qiu A, Tao Z, et al. Clinical impact of cardiovascular disease on patients with bronchiectasis. BMC Pulm Med, 2020, 20(1): 101.
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8.	陳璐, 司佳卉, 孫點劍一, 等. 中國成年人生活方式和心血管代謝因素與甲基化年齡加速的相關性分析. 中華流行病學雜志, 2022, 43(7): 1019-1029.
9.	Elsaid N, Saied A, Kandil H, et al. Impact of stress and hypertension on the cerebrovasculature. Front Biosci (Landmark Ed), 2021, 26(12): 1643-1652.
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11.	Müllerová H, Marshall J, Nigris ED, et al. Association of COPD exacerbations and acute cardiovascular events: a systematic review and meta-analysis. Ther Adv Respir Dis, 2022, 16: 17534666221113647.
12.	MT D, Criner GJ, Halpin DMG, et al. Time-dependent risk of cardiovascular events following an exacerbation in patients with chronic obstructive pulmonary disease: post hoc analysis from the IMPACT Trial. J Am Heart Assoc, 2022, 11(18): e024350.
13.	Navaratnam V, Root AA, Douglas I, et al. Cardiovascular outcomes after a respiratory tract infection among adults with non-cystic fibrosis bronchiectasis: a general population-based study. Ann Am Thorac Soc, 2018, 15(3): 315-321.
14.	Liu YL, Huang XY, Chen DB, et al. The detrimental qualitative and quantitative alterations of circulating endothelial progenitor cells in patients with bronchiectasis. Respir Med, 2021, 176: 106270.
15.	Choi H, Yang B, Kim YJ, et al. Increased mortality in patients with non cystic fibrosis bronchiectasis with respiratory comorbidities. Sci Rep, 2021, 11(1): 7126.
16.	Oscullo G, Gómez-Olivas JD, Beauperthuy T, et al. Impact and treatment of exacerbations in adults with bronchiectasis. Int J Tuberc Lung Dis, 2022, 26(7): 605-611.
17.	Crisafulli E, Guerrero M, Ielpo A, et al. Impact of bronchiectasis on outcomes of hospitalized patients with acute exacerbation of chronic obstructive pulmonary disease: a propensity matched analysis. Sci Rep, 2018, 8(1): 9236.
18.	Viniol C, Vogelmeier CF. Exacerbations of COPD. Eur Respir Rev, 2018, 27(147): 170103.
19.	Isiozor NM, Kunutsor SK, Voutilainen A, et al. Association between ideal cardiovascular health and risk of sudden cardiac death and all-cause mortality among middle-aged men in Finland. Eur J Prev Cardiol, 2021, 28(3): 294-300.
20.	Williams MC, Beek EJRV, Hill AT, et al. Coronary artery calcification on thoracic computed tomography is an independent predictor of mortality in patients with bronchiectasis. J Thorac Imaging, 2021, 36(3): 166-173.
21.	Chalmers JD, Polverino E, Crichton ML, et al. Bronchiectasis in Europe: data on disease characteristics from the European Bronchiectasis registry (EMBARC). Lancet Respir Med, 2023, S2213-2600(23): 00093-0.
22.	Keir HR, Chalmers JD. Pathophysiology of Bronchiectasis. Semin Respir Crit Care Med, 2021, 42(4): 499-512.
23.	Choi H, Kim SH, Han K, et al. Association between exercise and risk of cardiovascular diseases in patients with non-cystic fibrosis bronchiectasis. Respir Res, 2022, 23(1): 288.

1. Kelly C, Chalmers JD, Crossingham I, et al. Macrolide antibiotics for bronchiectasis. Cochrane Database Syst Rev, 2018, 3(3): CD012406.
2. Lee SC, Son KJ, Han CH, et al. Cardiovascular and cerebrovascular-associated mortality in patients with preceding bronchiectasis exacerbation. Ther Adv Respir Dis, 2022, 16: 17534666221144206.
3. Chen S, Qiu A, Tao Z, et al. Clinical impact of cardiovascular disease on patients with bronchiectasis. BMC Pulm Med, 2020, 20(1): 101.
4. Chen CL, Huang Y, Yuan JJ, et al. The roles of bacteria and viruses in bronchiectasis exacerbation: a prospective study. Arch Bronconeumol (Engl Ed), 2020, 56(10): 621-629.
5. Huang HY, Chung FT, Lin CY, et al. Influence of comorbidities and airway clearance on mortality and outcomes of patients with severe bronchiectasis exacerbations in Taiwan. Front Med (Lausanne), 2022, 8: 812775.
6. 成人支氣管擴張癥診治專家共識編寫組. 成人支氣管擴張癥診治專家共識(2012版). 中華危重癥醫學雜志(電子版), 2012, 5(5): 20-30.
7. Chalmers JD, Chang AB, Chotirmall SH, et al. Bronchiectasis. Nat Rev Dis Primers, 2018, 4(1): 45.
8. 陳璐, 司佳卉, 孫點劍一, 等. 中國成年人生活方式和心血管代謝因素與甲基化年齡加速的相關性分析. 中華流行病學雜志, 2022, 43(7): 1019-1029.
9. Elsaid N, Saied A, Kandil H, et al. Impact of stress and hypertension on the cerebrovasculature. Front Biosci (Landmark Ed), 2021, 26(12): 1643-1652.
10. Saiz LC, Gorricho J, Garjón J, et al. Blood pressure targets for the treatment of people with hypertension and cardiovascular disease. Cochrane Database Syst Rev, 2022, 11(11): CD010315.
11. Müllerová H, Marshall J, Nigris ED, et al. Association of COPD exacerbations and acute cardiovascular events: a systematic review and meta-analysis. Ther Adv Respir Dis, 2022, 16: 17534666221113647.
12. MT D, Criner GJ, Halpin DMG, et al. Time-dependent risk of cardiovascular events following an exacerbation in patients with chronic obstructive pulmonary disease: post hoc analysis from the IMPACT Trial. J Am Heart Assoc, 2022, 11(18): e024350.
13. Navaratnam V, Root AA, Douglas I, et al. Cardiovascular outcomes after a respiratory tract infection among adults with non-cystic fibrosis bronchiectasis: a general population-based study. Ann Am Thorac Soc, 2018, 15(3): 315-321.
14. Liu YL, Huang XY, Chen DB, et al. The detrimental qualitative and quantitative alterations of circulating endothelial progenitor cells in patients with bronchiectasis. Respir Med, 2021, 176: 106270.
15. Choi H, Yang B, Kim YJ, et al. Increased mortality in patients with non cystic fibrosis bronchiectasis with respiratory comorbidities. Sci Rep, 2021, 11(1): 7126.
16. Oscullo G, Gómez-Olivas JD, Beauperthuy T, et al. Impact and treatment of exacerbations in adults with bronchiectasis. Int J Tuberc Lung Dis, 2022, 26(7): 605-611.
17. Crisafulli E, Guerrero M, Ielpo A, et al. Impact of bronchiectasis on outcomes of hospitalized patients with acute exacerbation of chronic obstructive pulmonary disease: a propensity matched analysis. Sci Rep, 2018, 8(1): 9236.
18. Viniol C, Vogelmeier CF. Exacerbations of COPD. Eur Respir Rev, 2018, 27(147): 170103.
19. Isiozor NM, Kunutsor SK, Voutilainen A, et al. Association between ideal cardiovascular health and risk of sudden cardiac death and all-cause mortality among middle-aged men in Finland. Eur J Prev Cardiol, 2021, 28(3): 294-300.
20. Williams MC, Beek EJRV, Hill AT, et al. Coronary artery calcification on thoracic computed tomography is an independent predictor of mortality in patients with bronchiectasis. J Thorac Imaging, 2021, 36(3): 166-173.
21. Chalmers JD, Polverino E, Crichton ML, et al. Bronchiectasis in Europe: data on disease characteristics from the European Bronchiectasis registry (EMBARC). Lancet Respir Med, 2023, S2213-2600(23): 00093-0.
22. Keir HR, Chalmers JD. Pathophysiology of Bronchiectasis. Semin Respir Crit Care Med, 2021, 42(4): 499-512.
23. Choi H, Kim SH, Han K, et al. Association between exercise and risk of cardiovascular diseases in patients with non-cystic fibrosis bronchiectasis. Respir Res, 2022, 23(1): 288.

Chinese Journal of Respiratory and Critical Care Medicine

Cardiovascular events after acute exacerbation of bronchiectasis

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