Advanced Lung Cancer Inflammation Index (ALI) as an Independent Predictor for Bronchiectasis Exacerbation Risks

Purpose: Advanced lung cancer inflammation index (ALI), which is composed of the body mass index (BMI), serum albumin level, and blood neutrophil and lymphocyte levels, has been studied in various conditions, including cancers and non-malignant conditions, but not in bronchiectasis. Patients and methods: A prospective cohort study of Chinese patients with non-cystic fibrosis (CF) bronchiectasis was conducted in Hong Kong to investigate the association between baseline ALI and the risk of bronchiectasis exacerbation. ALI was assessed as a continuous variable, in quartiles, and cutoff values were determined using receiver operator curve (ROC) analysis. Results: A total of 148 Chinese patients were recruited, 60 of whom developed bronchiectasis exacerbation during the follow-up period. Lower baseline ALI was associated with an increased risk of bronchiectasis exacerbation in the follow-up period, with an adjusted odds ratio (aOR) of 1.06 (95% CI = 1.03– 1.09, p < 0.001) for every 10-unit decrease. The first to third quartiles of ALI were also associated with a significantly increased risk of bronchiectasis exacerbation, with aOR of 15.525 (95% CI = 3.927– 61.379) for Q1 (p < 0.001), 6.523 (95% CI = 1.730– 24.599) for Q2 (p = 0.006), and 7.272 (95% CI = 1.902– 27.800) for Q3 (p = 0.004). Patients with ALI less than 45.6 had a significantly increased risk of bronchiectasis exacerbation during the follow-up period, with an aOR of 3.829 (95% CI = 1.737– 8.442) (p< 0.001). Conclusion: ALI can independently predicting the risk of future exacerbation in patients with non-CF bronchiectasis. Lower ALI was associated with an increased risk of bronchiectasis exacerbation, with a proposed cutoff value of 45.6.