| BackgroundBronchiectasis(BE)is a common chronic respiratory disease characterized by cough,excessive sputum production,hemoptysis,and difficulty breathing.Repeated inflammation bacterial infection lung damage leads to impaired exercise tolerance and decreased quality of life,leading to frequent hospitalization and ultimately death,posing a serious economic burden on patients.Effectively identifying factors that may exacerbate the condition and making interventions is beneficial for improving patients’quality of life,delaying disease progression,and reducing mortality.Quantitative computed tomography(QCT)is an imaging technique that quantitatively measures lung parenchymal density and airway structure through calibration of body membranes and analysis software.It can quantify changes in emphysema and skeletal muscle mass on the basis of conventional chest CT.Many studies have proved that they are related to the progress and prognosis of many chronic respiratory diseases.The erector spinalis muscle and pectoralis major muscle are often quantified muscle groups in respiratory diseases.At present,there is evidence that patients with bronchiectasis also experience varying degrees of skeletal muscle abnormalities,but there is a lack of data related to quantitative CT.Therefore,this study observed the relationship between the quantifiable cross-sectional area of pectoralis major muscle,the cross-sectional area of erector spinalis muscle,emphysema and the time,times and death events of acute exacerbation hospitalization in patients with bronchiectasis within one year after discharge.PurposeTo explore the relationship between quantitative CT related indicators and adverse prognosis in patients with bronchiectasis in the next year,in order to identify patients at high risk of adverse outcomes.Subjects and MethodsThis study is a prospective study that included 242 patients admitted due to acute exacerbation of bronchiectasis.We collected general clinical data,disease severity scores,E-FACED scores,etc.of the subjects at admission,and conducted telephone follow-up every 3 months after discharge.We recorded the duration,frequency,and survival status of acute exacerbations after discharge,with a cumulative follow-up of1 year.Import the original CT images of the patient’s chest into the 3D Slicer software.The cross sectional area of pectoralis major muscle was measured on the first image above the aortic arch,and the cross sectional area of erector spinalis muscle was measured on the first image at the lower edge of the 12th thoracic spine,and the proportion of emphysema generated by automatic analysis of the software was recorded.The lower quartile was used to group the muscle cross-sectional area,and the upper quartile was used to group the emphysema.Use the Kaplan Meier survival function to compare the differences in muscle cross-sectional area and the proportion of emphysema among different groups in terms of mortality and first hospital stay.Cox univariate regression was used to analyze the risk factors for first acute exacerbation hospitalization,and variables with P<0.05 were included in Cox multivariate regression.Single factor Possion regression was used to analyze the risk factors for acute exacerbation of hospitalization,and variables with P<0.1 were included in the multivariate Possion regression.Cox univariate regression analysis was used to analyze the risk factors for death.A P value less than 0.05 is considered statistically significant for the difference.Results1.A total of 242 patients were included.During the one-year follow-up period,74 patients were hospitalized with acute exacerbations,and 13 patients died.The cross-sectional area of the pectoralis major muscle is 37.57(26.41,45.54)cm~2,and the cross-sectional area of the erector spinal muscle is 30.27(22.73,43.72)cm~2.The median proportion of emphysema is 13.2%(2.03,27.47)%.2.Kaplan-Meier survival function was used to analyze the correlation between muscle cross-sectional area and the first acute exacerbation of emphysema among different groups of patients within one year.The results showed that the first acute exacerbation rate was higher in the decreased pectoralis major muscle cross-sectional area group than in the non decreased group,the decreased erector spinal muscle cross-sectional area group than in the non decreased group,and the high proportion of emphysema group than in the lower group,with statistically significant differences(P<0.05).3.Univariate Cox regression analysis showed that pectoralis major cross-sectional area<26.41 cm~2(HR=1.979,95%CI 1.232-3.179,P=0.005),erector spinal muscle cross-sectional area<22.73 cm~2(HR=2.226,95%CI 1.395-3.552,P=0.001),and emphysema≥27.47%(HR=3.511,95%CI 2.220-5.553,P<0.001)were the risk factors for the first acute exacerbation of hospitalization in patients with bronchiectasis within one year after discharge.4.The variables with P<0.05 in Cox univariate regression analysis were included in the multivariate Cox regression analysis.The results showed that the decrease in the cross sectional area of pectoralis major muscle(HR=1.915,95%CI 1.112-3.295,P=0.019),the decrease in the cross sectional area of erector spinal muscle(HR=1.455,95%CI 1.033-2.049,P=0.036),and the increase in emphysema(HR=2.523,95%CI1.423-4.476,P=0.002)were independent risk factors for the first acute exacerbation of hospitalization within one year after discharge of patients with bronchiectasis.5.Possion univariate regression analysis of risk factors for acute exacerbation of hospitalization in patients with bronchiectasis within one year.The results showed that the risk of acute aggravating hospital events in the reduced pectoralis major cross sectional area group was 2.265 times that in the non reduced group(IRR=2.265,95%CI 1.573-3.260,P<0.001),and the risk of acute aggravating hospital events in the reduced erector spinal muscle cross sectional area group was 2.203 times that in the non reduced group(IRR=2.203,95%CI 1.528-3.175,P<0.001).The risk of acute exacerbation of hospitalization events in the group with higher levels of emphysema was 4.233 times higher than that in the group with lower levels(IRR=4.233,95%CI2.964-6.046,P<0.001).6.The variables with P<0.1 in the univariate Posion regression analysis were included in the multivariate Posion regression analysis.The results showed that the cross-sectional area of pectoralis major muscle<26.41 cm~2(IRR=1.978,95%CI1.034-3.786,P=0.009)and the cross-sectional area of erector spinal muscle<22.73cm~2(IRR=2.437,95%CI 1.110-5.349,P=0.041)were independent risk factors for the number of acute exacerbations in patients with bronchiectasis within one day after discharge.7.Kaplan Meier survival function analysis and Cox univariate regression analysis were used to investigate the association between different muscle cross-sectional area groups,emphysema groups,and death events.The results showed that the reduction of pectoralis major cross sectional area,the reduction of erector spinal muscle cross sectional area,and the increase of the proportion of emphysema were not predictive factors for the death of patients with bronchiectasis within one year after discharge.Conclusion1.The reduction of pectoralis major cross-sectional area is an independent risk factor for the first acute exacerbation hospitalization and the number of acute exacerbations within 1 year after discharge of patients with bronchiectasis.2.The reduction in cross-sectional area of the erector spinalis muscle is an independent risk factor for the first acute exacerbation hospitalization and the number of acute exacerbations in patients with bronchiectasis within one year after discharge.3.Elevated emphysema is an independent risk factor for patients with bronchiectasis who experience their first acute exacerbation of hospitalization within one year after discharge,and it is also a risk factor for the frequency of acute exacerbations.4.The decrease of pectoralis major muscle cross-sectional area,the decrease of erector spinal muscle cross-sectional area,and the increase of emphysema are not predictors of death within 1 year after discharge of patients with bronchiectasis. |
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