title: Bronchiectasis Rheumatoid Overlap Syndrome Is an Independent Risk Factor for Mortality in Patients With Bronchiectasis: A Multicenter Cohort Study.
abstract: This study assessed if bronchiectasis (BR) and rheumatoid arthritis (RA), when manifesting as an overlap syndrome (BROS), were associated with worse outcomes than other BR etiologies applying the Bronchiectasis Severity Index (BSI).
  
  
  
  Data were collected from the BSI databases of 1,716 adult patients with BR across six centers: Edinburgh, United Kingdom (608 patients); Dundee, United Kingdom (n = 286); Leuven, Belgium (n = 253); Monza, Italy (n = 201); Galway, Ireland (n = 242); and Newcastle, United Kingdom (n = 126). Patients were categorized as having BROS (those with RA and BR without interstitial lung disease), idiopathic BR, bronchiectasis-COPD overlap syndrome (BCOS), and "other" BR etiologies. Mortality rates, hospitalization, and exacerbation frequency were recorded.
  
  
  
  A total of 147 patients with BROS (8.5% of the cohort) were identified. There was a statistically significant relationship between BROS and mortality, although this relationship was not associated with higher rates of BR exacerbations or BR-related hospitalizations. The mortality rate over a mean of 48 months was 9.3% for idiopathic BR, 8.6% in patients with other causes of BR, 18% for RA, and 28.5% for BCOS. Mortality was statistically higher in patients with BROS and BCOS compared with those with all other etiologies. The BSI scores were statistically but not clinically significantly higher in those with BROS compared with those with idiopathic BR (BSI mean, 7.7 vs 7.1, respectively; P < .05). Patients with BCOS had significantly higher BSI scores (mean, 10.4), Pseudomonas aeruginosa colonization rates (24%), and previous hospitalization rates (58%).
  
  
  
  Both the BROS and BCOS groups have an excess of mortality. The mechanisms for this finding may be complex, but these data emphasize that these subgroups require additional study to understand this excess mortality.
authors.affiliation: Adult Bronchiectasis Service & Sir William Leech Centre for Lung Research, Freeman Hospital, Heaton, Newcastle, UK; Institute of Cellular Medicine, Newcastle University, Newcastle, UK. Electronic address: anthony.de-soyza@ncl.ac.uk.
authors.forename: Anthony
authors.initials: A
authors.lastname: De Soyza
authors.affiliation: Institute of Cellular Medicine, Newcastle University, Newcastle, UK; Department of Respiratory Medicine, Galway University Hospitals, Galway, Ireland.
authors.forename: Melissa J
authors.initials: MJ
authors.lastname: McDonnell
authors.affiliation: University Hospital Gasthuisberg, Respiratory Medicine, Leuven, Belgium.
authors.forename: Pieter C
authors.initials: PC
authors.lastname: Goeminne
authors.affiliation: Department of Pathophysiology and Transplantation, University of Milan Fondazione IRCCS Ca' Granda Ospedale Maggiore Policlinico, Milan, Italy.
authors.forename: Stefano
authors.initials: S
authors.lastname: Aliberti
authors.affiliation: Department of Health Science, University of Milan Bicocca, Clinica Pneumologica, Monza, Italy.
authors.forename: Sara
authors.initials: S
authors.lastname: Lonni
authors.affiliation: Adult Bronchiectasis Service & Sir William Leech Centre for Lung Research, Freeman Hospital, Heaton, Newcastle, UK.
authors.forename: John
authors.initials: J
authors.lastname: Davison
authors.affiliation: University Hospital Gasthuisberg, Respiratory Medicine, Leuven, Belgium.
authors.forename: Lieven J
authors.initials: LJ
authors.lastname: Dupont
authors.affiliation: Tayside Respiratory Research Group, University of Dundee, Dundee, UK.
authors.forename: Thomas C
authors.initials: TC
authors.lastname: Fardon
authors.affiliation: Department of Respiratory Medicine, Galway University Hospitals, Galway, Ireland.
authors.forename: Robert M
authors.initials: RM
authors.lastname: Rutherford
authors.affiliation: Department of Respiratory Medicine, Royal Infirmary of Edinburgh and the University of Edinburgh, Edinburgh, UK.
authors.forename: Adam T
authors.initials: AT
authors.lastname: Hill
authors.affiliation: Tayside Respiratory Research Group, University of Dundee, Dundee, UK.
authors.forename: James D
authors.initials: JD
authors.lastname: Chalmers
mesh_terms: D000368:Aged; D001172:Arthritis, Rheumatoid / Q000453:epidemiology*; D001530:Belgium / Q000453:epidemiology; D001987:Bronchiectasis / Q000401:mortality*; D015331:Cohort Studies; D015897:Comorbidity; D018450:Disease Progression; D005260:Female; D006760:Hospitalization / Q000706:statistics & numerical data*; D006801:Humans; D007494:Ireland / Q000453:epidemiology; D007558:Italy / Q000453:epidemiology; D008297:Male; D008875:Middle Aged; D029424:Pulmonary Disease, Chronic Obstructive / Q000453:epidemiology*; D012307:Risk Factors; D012720:Severity of Illness Index; D013577:Syndrome; D006113:United Kingdom / Q000453:epidemiology
keywords: COPD; bronchiectasis; mortality; rheumatoid arthritis