Prognostic factors of pulmonary exacerbations severity in pediatric bronchiectasis: a retrospective cohort study

Abstract

Abstract Background Pulmonary exacerbations have been found to negatively impact the natural course of pediatric bronchiectasis. However, prognostic factors that might predict the severity of exacerbations are poorly identified. Therefore, this study was designed to identify the best prognostic factors associated with pulmonary exacerbations severity in pediatric bronchiectasis. Results This retrospective cohort study involved fifty stable bronchiectasis patients including cystic fibrosis (CF) and non-CF bronchiectasis under the age of 18 years. The pulmonary exacerbations during the previous year were reviewed among the studied patients determining their relations with bacterial colonization, inflammatory markers, lung function, and severity scores. The severity of pulmonary exacerbations was directly related to the number of hospitals and ICU admissions (P < 0.001, P < 0.001), exacerbations frequency (P < 0.001), SPEX score (P = 0.002), inflammatory markers as sputum neutrophil elastase (P < 0.001), C-reactive protein (CRP) (P < 0.001), Respiratory and Systemic Symptoms Questionnaire (RSSQ) (P < 0.001), Acute Respiratory Illness Checklist (ARIC) (P < 0.001), cough severity score (P < 0.001), and bronchiectasis severity index (BSI) (P = 0.009) in all bronchiectasis patients. Additional significant relations were found between exacerbations severity with pseudomonas colonization and FACED score (P = 0.002, P = 0.010) among CF patients and with lower body mass index (BMI) and older age (P = 0.035, P < 0.001) among non-CF bronchiectasis patients respectively. Conclusions Pulmonary exacerbations are prevalent among both pediatric CF and non-CF bronchiectasis patients. In this population, the best prognostic factors for pulmonary exacerbation severity were the frequency of ICU admissions and BSI more than 11 identifying their importance during bronchiectasis assessment.