Risk Factors for Influenza-Induced Exacerbations and Mortality in Non-Cystic Fibrosis Bronchiectasis

Hung-Yu Huang; Chun-Yu Lo; Fu-Tsai Chung; Yu-Tung Huang; Po-Chuan Ko; Chang-Wei Lin; Yu-Chen Huang; Kian Fan Chung; Chun-Hua Wang

doi:10.3390/v15020537

Risk Factors for Influenza-Induced Exacerbations and Mortality in Non-Cystic Fibrosis Bronchiectasis

Viruses. 2023 Feb 14;15(2):537. doi: 10.3390/v15020537.

Authors

Hung-Yu Huang^{1

2

3}, Chun-Yu Lo^{1

2}, Fu-Tsai Chung^{1

2

3}, Yu-Tung Huang⁴, Po-Chuan Ko⁴, Chang-Wei Lin^{1

2}, Yu-Chen Huang^{1

2}, Kian Fan Chung^{5

6}, Chun-Hua Wang^{1

2}

Affiliations

¹ Department of Thoracic Medicine, Chang Gung Memorial Hospital, Taipei 105, Taiwan.
² College of Medicine, Chang Gung University, Taoyuan 333, Taiwan.
³ Department of Thoracic Medicine, New Taipei City Municipal TuCheng Hospital, Chang Gung Medical Foundation, New Taipei City 236, Taiwan.
⁴ Center for Big Data Analytics and Statistics, Chang Gung Memorial Hospital, Taoyuan 333, Taiwan.
⁵ Airway Disease Section, National Heart and Lung Institute, Imperial College London, London W2 1PG, UK.
⁶ Biomedical Research Unit, Royal Brompton Hospital, London SW7 2BX, UK.

Abstract

Influenza infection is a cause of exacerbations in patients with chronic pulmonary diseases. The aim of this study was to investigate the clinical outcomes and identify risk factors associated with hospitalization and mortality following influenza infection in adult patients with bronchiectasis. Using the Chang Gung Research Database, we identified patients with bronchiectasis and influenza-related infection (ICD-9-CM 487 and anti-viral medicine) between 2008 and 2017. The main outcomes were influenza-related hospitalization and in-hospital mortality rate. Eight hundred sixty-five patients with bronchiectasis and influenza infection were identified. Five hundred thirty-six (62%) patients with bronchiectasis were hospitalized for influenza-related infection and 118 (22%) patients had respiratory failure. Compared to the group only seen in clinic, the hospitalization group was older, with more male patients, a lower FEV_1, higher bronchiectasis aetiology comorbidity index (BACI), and more acute exacerbations in the previous year. Co-infections were evident in 55.6% of hospitalized patients, mainly caused by Pseudomonas aeruginosa (15%), fungus (7%), and Klebsiella pneumoniae (6%). The respiratory failure group developed acute kidney injury (36% vs. 16%; p < 0.001), and shock (47% vs. 6%; p < 0.001) more often than influenza patients without respiratory failure. The overall mortality rate was 10.8% and the respiratory failure group exhibited significantly higher in-hospital mortality rates (27.1% vs. 6.2%; p < 0.001). Age, BACI, and previous exacerbations were independently associated with influenza-related hospitalization. Age, presence of shock, and low platelet counts were associated with increased hospital mortality. Influenza virus caused severe exacerbation in bronchiectasis, especially in those who were older and who had high BACI scores and previous exacerbations. A high risk of respiratory failure and mortality were observed in influenza-related hospitalization in bronchiectasis. We highlight the importance of preventing or treating influenza infection in bronchiectasis.

Keywords: acute exacerbations; bacteria; bronchiectasis; co-infection; influenza.

Publication types

Research Support, Non-U.S. Gov't

MeSH terms

Adult
Bronchiectasis* / complications
Fibrosis
Humans
Influenza, Human* / complications
Male
Respiratory Insufficiency* / etiology
Risk Factors

Grants and funding

Supported by Chang Gung Memorial Hospital Research Project Grant (CGRPVVN0011; CMRPG3K2061, CMRPG3I0401, CMRPG3I0402, and CMRPVVM0171) and the Maintenance Project of the Center for Big Data Analytics and Statistics (Grant CLRPG3D0049, Grant CLRPG3N0011) at Chang Gung Memorial Hospital.