Determinants of survival in the European Bronchiectasis Registry(EMBARC)

There is limited data on mortality in bronchiectasis (BE). Risk factors (RF) for mortality over up to 4 years were examined using Cox’s proportional hazards regression in the EMBARC registry, an observational cohort study across 30 European countries beginning in 2015. 13,051 patients were prospectively recruited with a median age of 67 yrs and median FEV1 of 77%. 612 deaths were recorded. Increased mortality was associated with increased age (HR 1.05 95% CI 1.03-1.06,p<0.0001), later age at diagnosis (HR 1.02 95% CI 1.00-1.03,p=0.009), co-morbidities (HR 1.27 95% CI 1.21-1.34,p<0.0001), FEV1 (<30% predicted HR 5.90 95% CI 4-8.79, p<0.0001, 30-50% HR 3.48 95% CI 2.61-4.65,p<0.0001, 50-80% HR 3.48 95% CI 2.61-4.65,p<0.0001), frequency of exacerbations (HR 1.05 95% CI 1.02-1.08,p=0.003), P. aeruginosa infection (HR 1.36 95% CI 1.02-1.82,p=0.03). Rheumatoid arthritis (HR 1.96 95% CI 1.17-3.27,p=0.01), COPD (1.46 95% CI 1.04-2.04,p=0.03) and baseline respiratory symptoms including the QoL-B symptom scale (HR 0.99 95% 0.98-0.996, p<0.0001) were associated with higher mortality. These RF were more frequent in specialist centres but after accounting for patient characteristics, mortality was significantly lower among patients cared for in specialist centres (HR 0.81 95% CI 0.68-0.97,p<0.0001). Initial survival data from the EMBARC registry suggests that symptoms, exacerbations and P. aeruginosa infection are potentially modifiable risk factors for death. The lower mortality in specialist centres despite high disease severity suggests that improved quality of care could reduce mortality in BE. This work was supported by the IMI and EFPIA companies under the European Commission funded project, iABC (grant 115721)