Abstract Rationale Radiographic bronchiectasis (BE) on chest CT is common in COPD, yet its prognostic value, especially in the absence of features associated with clinical significance (CS), remains uncertain. This study aims to assess the association between radiographic BE, with or without clinically significant features, and the risk of future exacerbations and mortality. Methods We analyzed data from 870 participants in the SubPopulations and InteRmediate Outcome Measures in COPD Study (SPIROMICS). BE was identified via qualitative radiographic evaluation of chest CTs. CS was defined by having two out of the three following features: 1) cough and/or 2) phlegm most or several days per week and/or 3) more than one exacerbation in the prior year. Outcomes were Hazard Ratio (HR) for first exacerbation and all-cause mortality analyzed by univariate Kaplan-Meier curves, and multivariable Cox proportional hazards models. We analyzed 870 SubPopulations and InteRmediate Outcome Measures in COPD Study participants with qualitative CT reads for bronchiectasis. Clinically significant features were defined as at least two of the following: cough and/or phlegm most or several days per week, and at least one exacerbation in the prior year. Outcomes were Hazard Ratio (HR) to first exacerbation and all-cause mortality. Univariate Kaplan Meier and multivariable Cox models adjusted for age, sex, smoking pack years, and FEV1 percent predicted were used. Results Even in the absence of CS features, a BE diagnosis was associated with an increased risk for future exacerbations (HR 1.4, 95%CI 1-2) and mortality (HR 2.2, 95%CI 1.1-4.5). Participants with BE and a history of prior exacerbations had an 8-fold increased risk for future exacerbations (HR 7.8, 95%CI 5.1-11.9) and mortality (HR 8.6, 95%CI 3.9-19.4) compared to the reference group without BE and exacerbations. This association remained statistically significant after adjusting for covariates. Conclusion BE diagnosis is associated with increased risk for future exacerbations and dying, particularly among individuals with prior exacerbations. These findings support further investigation into quantitative imaging approaches to improve our understanding of how this condition affects clinical outcomes in this high-risk population. This abstract is funded by: SPIROMICS was supported by contracts from the NIH/NHLBI (HHSN268200900013C, HHSN268200900014C, HHSN268200900015C, HHSN268200900016C, HHSN268200900017C, HHSN268200900018C, HHSN268200900019C, HHSN268200900020C, 75N92024D00012), grants from the NIH/NHLBI (U01HL137880, U24HL141762, R01HL182622, R01HL144718, and R01HL093081), and supplemented by contributions made through the Foundation for the NIH and the COPD Foundation from Amgen; AstraZeneca/MedImmune; Bayer; Bellerophon Therapeutics; Boehringer-Ingelheim Pharmaceuticals, Inc.; Bristol Myers Squibb; Chiesi Farmaceutici S.p.A.; Forest Research Institute, Inc.; Genentech; GlaxoSmithKline; Grifols Therapeutics, Inc.; Ikaria, Inc.; MGC Diagnostics; Novartis Pharmaceuticals Corporation; Nycomed GmbH; Polarean; ProterixBio; Regeneron Pharmaceuticals, Inc.; Sanofi; Sunovion; Takeda Pharmaceutical Company; Theravance Biopharma; Verona; and Mylan/Viatris.
Sipsey et al. (Fri,) studied this question.