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Patients with bronchiectasis face heightened risks of severe exacerbation and mortality after COVID-19 recovery, especially following severe cases.
Individuals with bronchiectasis face an increased risk of exacerbation and mortality following recovery from COVID-19, particularly after severe cases, according to a study published in ERJ Open Research.1
Past research determined that COVID-19 may trigger exacerbations in this population, even after recovery.2 However, these studies were limited by small sample sizes, a focus on mild to moderate cases, and a lack of data on long-term mortality.1 As a result, the impact of COVID-19 severity on severe exacerbation and mortality risk in patients with bronchiectasis remained unclear.
Patients with bronchiectasis face heightened risks of severe exacerbation and mortality after COVID-19 recovery, especially following severe cases. | Image Credit: Production Perig - stock.adobe.com
To address these gaps, the researchers evaluated long-term risks of exacerbation and mortality among patients with bronchiectasis following recovery from both severe and nonsevere COVID-19 cases. They used data from the Republic of Korea’s National Health Insurance Service, a mandatory universal health care provider covering about 97% of the population.3 Eligible individuals were diagnosed with bronchiectasis between January 1, 2015, and October 7, 2020.1
The study’s primary outcomes were the long-term risk of severe bronchiectasis exacerbation and all-cause mortality. To evaluate exacerbation risk, patients were followed until the first occurrence of severe exacerbation, death, or December 31, 2021, whichever came first. For the mortality analysis, follow-up continued until death or September 30, 2022.
Among 48,342 eligible individuals with bronchiectasis, 2711 had recovered from COVID-19. After 1:1 propensity score matching, a COVID-19 cohort (n = 2711) and a matched cohort (n = 2711) were included in the final analysis.
The COVID-19 cohort was further stratified by disease severity: 536 had severe COVID-19, and 2175 had nonsevere COVID-19. Patients in the severe COVID-19 cohort were more likely to be older (median age, 73 vs 67; standardized mean difference [SMD], 0.39) and male (52.4% vs 40.0%; SMD, 0.17) than those in the nonsevere COVID-19 cohort.
Over a median follow-up of 70 days (IQR, 31-216), including a median 14-day COVID-19 recovery period, the incidence of severe bronchiectasis exacerbation was 305.6 per 10,000 person-years in the matched cohort and 402.2 per 10,000 person-years in the COVID-19 cohort. Stratified by COVID-19 severity, the incidence was 273.3 per 10,000 person-years in the non-severe cohort and 855.9 per 10,000 person-years in the severe cohort.
As a result, the severe COVID-19 cohort had a significantly higher risk of severe exacerbation compared with the matched cohort (adjusted HR [aHR], 2.38; 95% CI, 1.25-4.51). However, this increased risk was not observed in the nonsevere cohort.
Similarly, during a median follow-up of 71 days (IQR, 32-129), including the 14-day recovery period, the all-cause mortality rate was 221.2 per 10,000 person-years in the matched cohort and 342.9 per 10,000 person-years in the COVID-19 cohort (P = .001). The researchers highlighted that the COVID-19 cohort exhibited a significantly higher mortality risk than the matched cohort (aHR, 1.46; 95% CI, 1.06-2.01).
When broken down by COVID-19 severity, the mortality rate was 149.6 per 10,000 person-years in the non-severe cohort and 1132.1 per 10,000 person-years in the severe COVID-19 cohort (P < .001). Therefore, the severe COVID-19 cohort had a significantly higher mortality risk than the matched cohort (aHR, 2.99; 95% CI, 2.08-4.28). In contrast, the nonsevere cohort did not demonstrate a significantly higher mortality risk.
Lastly, the researchers acknowledged the limitations of their study, including the potential lack of generalizability due to its single-country setting. Still, they expressed confidence in the findings and their clinical implications.
“Our findings suggest that guidelines should emphasize vigilant monitoring…and include specific recommendations for managing COVID-19 in individuals with bronchiectasis,” the authors wrote. “Early and appropriate management may help prevent severe exacerbations. Furthermore, interventions such as pulmonary rehabilitation should be explored to prevent subsequent exacerbations.”
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