Objective sputum colour assessment and clinical outcomes in bronchiectasis: data from the European Bronchiectasis Registry (EMBARC).
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Aliberti Stefano, Ringshausen Felix C, Dhar Raja, Haworth Charles S, Loebinger Michael R, Dimakou Katerina, Crichton Megan L, De Soyza Anthony, Vendrell Montse, Burgel Pierre-Regis, McDonnell Melissa, Skrgat Sabina, Maiz Carro Luis, de Roux Andres, Sibila Oriol, Bossios Apostolos, van der Eerden Menno, Kauppi Paula, Wilson Robert, Milenkovic Branislava, Menendez Rosario, Murris Marlene, Borekci Sermin, Munteanu Oxana, Obradovic Dusanka, Nowinski Adam, Amorim Adelina, Torres Antoni, Lorent Natalie, Van Braeckel Eva, Altenburg Josje, Shoemark Amelia, Shteinberg Michal, Boersma Wim, Goeminne Pieter C, Elborn J Stuart, Hill Adam T, Welte Tobias, Blasi Francesco, Polverino Eva, Chalmers James D, EMBARC Registry Investigators
Аннотация
METHODS: We used a prospective, observational registry of adults with bronchiectasis conducted in 31 countries. Patients who did not produce spontaneous sputum were excluded from the analysis. The Murray sputum colour chart was used at baseline and at follow-up visits. Key outcomes were frequency of exacerbations, hospitalisations for severe exacerbations and mortality during up to 5-year follow-up.
RESULTS: 13 484 patients were included in the analysis. More purulent sputum was associated with lower forced expiratory volume in 1 s (FEV1), worse quality of life, greater bacterial infection and a higher bronchiectasis severity index. Sputum colour was strongly associated with the risk of future exacerbations during follow-up. Compared to patients with mucoid sputum (reference group), patients with mucopurulent sputum experienced significantly more exacerbations (incident rate ratio (IRR) 1.29, 95% CI 1.22-1.38; p<0.0001), while the rates were even higher for patients with purulent (IRR 1.55, 95% CI 1.44-1.67; p<0.0001) and severely purulent sputum (IRR 1.91, 95% CI 1.52-2.39; p<0.0001). Hospitalisations for severe exacerbations were also associated with increasing sputum colour with rate ratios, compared to patients with mucoid sputum, of 1.41 (95% CI 1.29-1.56; p<0.0001), 1.98 (95% CI 1.77-2.21; p<0.0001) and 3.05 (95% CI 2.25-4.14; p<0.0001) for mucopurulent, purulent and severely purulent sputum, respectively. Mortality was significantly increased with increasing sputum purulence, hazard ratio 1.12 (95% CI 1.01-1.24; p=0.027), for each increment in sputum purulence.
CONCLUSION: Sputum colour is a simple marker of disease severity and future risk of exacerbations, severe exacerbations and mortality in patients with bronchiectasis.