Analysis Of Risk Factors For Poor Prognosis In Patients With Acute Exacerbation Of Bronchiectasis

Objective: Patients with acute exacerbations of bronchiectasis(BE)often have progressive disease progression,which severely affects quality of life.This study aims to reduce the occurrence of acute exacerbations in patients with bronchiectasis by analyzing common indicators in the clinic,identifying risk factors for disease progression,focusing on clinical outcomes of patients,and assessing disease risk stratification.Methods: Clinical data related to patients with acute exacerbation of bronchiectasis attending the First Hospital of Lanzhou University in Gansu Province from January 2019 to February 2022 were collected,and 160 patients with acute exacerbation of bronchiectasis were selected as study subjects according to the inclusion and exclusion criteria.Patients who were readmitted within 90 days after discharge and those who died and were readmitted within 90 days after discharge were classified as the poor prognosis group,and the rest were classified as the good prognosis group.The clinical data of the two groups were studied by retrospective cohort analysis using SPSS25.0 software.Results:1.The results of general data of patients in both groups showed that the poor prognosis group had higher levels of age,bronchiectasis etiological disease index(BACI),prognostic nutritional index(PNI),geriatric nutritional risk index(GNRI),and higher frequency of pulmonary hypertension and pathogenic bacterial infections compared to the good prognosis group(P<0.05).2.Laboratory indexes in both groups showed that plasma albumin(ALB),erythrocyte pressure volume,and hemoglobin levels were lower in the poor prognosis group compared with the good prognosis group(P<0.05);while erythrocyte sedimentation rate levels were higher(P<0.05);the remaining indexes serum total protein,blood glucose,blood creatinine,calcitoninogen(PCT),fibrinogen(FIB),neutrophils,eosinophils There was no statistically significant difference in the size of granulocytes,lymphocytes,leukocytes,red blood cells,and platelets(P>0.05).3.The scoring system of the two groups showed that the levels of bronchiectasis severity index(BSI),bronchiectasis severity grading score(FACED),and modified bronchiectasis severity grading score(E-FACED)were higher in the poor prognosis group compared with the good prognosis group(P<0.05).4.Multiple regression analysis was performed,and age,BACI,and pulmonary hypertension were found to be independent risk factors for poor prognosis in patients with acute exacerbation of bronchiectasis(P<0.05);age,BACI,and the combined index of both were analyzed by Receiver Operating Characteristic(ROC)curves,and the results suggested that age,The area under the ROC curve was 0.654,0.640 and 0.698 for the BACI score and the combined diagnostic index,respectively.5.Spearman’s correlation analysis revealed that FACED,E-FACED and BSI were positively correlated with SIINI,neutrophil-to-lymphocyte ratio(NLR),neutrophil percentage,PCT and FIB(P<0.05),and negatively correlated with ALB,PNI and lymphocyte percentage(P<0.05).And the correlation between SIINI and FACED,E-FACED and BSI was higher than other blood indicators.6.A subgroup analysis of the BACI score,an independent risk factor for poor prognosis in patients with acute exacerbation of bronchiectasis,showed that the hospitalization rate,mortality and frequency of respiratory failure were higher in the BACI≥6 group than in the BACI<6 group.Further univariate analysis revealed that mortality was associated with BACI,age,FACED,E-FACED,ALB,PNI,GNRI,and chronic colonization of pathogenic bacteria,with statistically significant differences(P<0.05),and further analysis by COX multifactor regression showed that BACI,age,ALB,and chronic colonization of pathogenic bacteria were the independent influencing factors.Conclusion:1.Age,pulmonary hypertension and BACI are risk factors for poor prognosis in patients with acute exacerbations of bronchiectasis.2.The combined diagnostic index of age and BACI is a better predictor of poor prognosis in patients with acute exacerbation of bronchiectasis than individual indexes.3.The new inflammatory indicators SIINI and NLR can be used as indirect observation indicators for the assessment of patients with acute exacerbation of bronchiectasis.4.The cumulative incidence of death,hospitalization and frequency of respiratory failure were significantly higher in the BACI ≥ 6 subgroup than in the BACI<6 subgroup,and the BACI score could be a good indicator of the severity of BE disease and the risk of outcome.