title: Clinical phenotypes in adult patients with bronchiectasis.
abstract: Bronchiectasis is a heterogeneous disease. This study aimed at identifying discrete groups of patients with different clinical and biological characteristics and long-term outcomes.This was a secondary analysis of five European databases of prospectively enrolled adult outpatients with bronchiectasis. Principal component and cluster analyses were performed using demographics, comorbidities, and clinical, radiological, functional and microbiological variables collected during the stable state. Exacerbations, hospitalisations and mortality during a 3-year follow-up were recorded. Clusters were externally validated in an independent cohort of patients with bronchiectasis, also investigating inflammatory markers in sputum.Among 1145 patients (median age 66 years; 40% male), four clusters were identified driven by the presence of chronic infection with Pseudomonas aeruginosaor other pathogens and daily sputum: "Pseudomonas" (16%), "Other chronic infection" (24%), "Daily sputum" (33%) and "Dry bronchiectasis" (27%). Patients in the four clusters showed significant differences in terms of quality of life, exacerbations, hospitalisations and mortality during follow-up. In the validation cohort, free neutrophil elastase activity, myeloperoxidase activity and interleukin-1β levels in sputum were significantly different among the clusters.Identification of four clinical phenotypes in bronchiectasis could favour focused treatments in future interventional studies designed to alter the natural history of the disease.
authors: School of Medicine and Surgery, University of Milan Bicocca, AO San Gerardo, Monza, Italy stefano.aliberti@unimib.it.
authors: Stefano
authors: S
authors: Aliberti
authors: School of Medicine and Surgery, University of Milan Bicocca, AO San Gerardo, Monza, Italy.
authors: Sara
authors: S
authors: Lonni
authors: Clinical Epidemiology and Medical Statistics Unit, Dept of Biomedical Sciences, University of Sassari - Research, Medical Education and Professional Development Unit, AOU Sassari, Sassari, Italy.
authors: Simone
authors: S
authors: Dore
authors: Dept of Respiratory Medicine, Galway University Hospitals, Galway, Ireland.
authors: Melissa J
authors: MJ
authors: McDonnell
authors: Dept of Respiratory Medicine, University Hospital Gasthuisberg, Leuven, Belgium Dept of Respiratory Medicine, UZ Leuven, Leuven, Belgium.
authors: Pieter C
authors: PC
authors: Goeminne
authors: 5th Pulmonary Dept, "Sotiria" Chest Hospital, Athens, Greece.
authors: Katerina
authors: K
authors: Dimakou
authors: Tayside Respiratory Research Group, University of Dundee, Dundee, UK.
authors: Thomas C
authors: TC
authors: Fardon
authors: Dept of Respiratory Medicine, Galway University Hospitals, Galway, Ireland.
authors: Robert
authors: R
authors: Rutherford
authors: School of Medicine and Surgery, University of Milan Bicocca, AO San Gerardo, Monza, Italy.
authors: Alberto
authors: A
authors: Pesci
authors: Division of Pulmonary Diseases and Critical Care, South Texas Veterans Health Care System and University of Texas Health Science Center, San Antonio, TX, USA.
authors: Marcos I
authors: MI
authors: Restrepo
authors: Clinical Epidemiology and Medical Statistics Unit, Dept of Biomedical Sciences, University of Sassari - Research, Medical Education and Professional Development Unit, AOU Sassari, Sassari, Italy.
authors: Giovanni
authors: G
authors: Sotgiu
authors: Tayside Respiratory Research Group, University of Dundee, Dundee, UK.
authors: James D
authors: JD
authors: Chalmers
mesh_terms: D000368:Aged; D001987:Bronchiectasis / Q000175:diagnosis* / Q000382:microbiology / Q000503:physiopathology; D016000:Cluster Analysis; D005060:Europe; D005260:Female; D006801:Humans; D007249:Inflammation; D008297:Male; D008875:Middle Aged; D010641:Phenotype; D025341:Principal Component Analysis; D011446:Prospective Studies; D011552:Pseudomonas Infections / Q000503:physiopathology; D011550:Pseudomonas aeruginosa; D011788:Quality of Life; D013183:Sputum / Q000737:chemistry / Q000382:microbiology; D016896:Treatment Outcome