Background

In adult patients with bronchiectasis (BE) the identification of the underlying aetiology may be difficult. In a new patient with BE the performance of a panel of tests is recommended, even though this practice may be expensive and the level of evidence supporting is low. We aimed to identify a panel of variables able to predict the aetiological diagnosis of BE.

Methods

Our prospective study derived from our real-life experience on the management of adult stable BE outpatients. We recorded variables concerning clinical, radiological, microbiological and laboratory features. We identified five groups of aetiological diagnosis of BE (idiopathic, post-infective, COPD, asthma and non-common diseases [immunodeficiency or other rare conditions]). Multivariate models were used to identify predictors of each aetiological diagnosis. The suitability of performing a specific test for the diagnosis was also considered.

Results

We enrolled 354 patients with a new diagnosis of BE. Patients with different aetiological causes differed significantly with regard to age, sex, smoking habit, comorbidities, dyspnoea perception, airflow obstruction and severity scores. Various predictors were assessed, including sex, previous respiratory infections, diffuse localization of BE, risk scores, and laboratory variables (sodium and eosinophils). The levels of autoantibodies or immunoglobulins were reserved for the diagnosis of non-common disease.

Conclusion

Our research confirms that some predictors are specific for the aetiological diagnosis of BE. The possibility of integrating this information may represent a useful tool for the diagnosis. The execution of certain specific tests should be reserved for patients with a non-common disease.

中文翻译：

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新成人支气管扩张患者的病因学诊断：来自现实生活经验的预测因子的作用。

背景

在成年支气管扩张患者中，潜在病因的鉴定可能很困难。对于新发BE患者，建议进行一组检查，即使这种做法可能很昂贵且证据支持水平较低。我们旨在确定一组能够预测BE病因诊断的变量。

方法

我们的前瞻性研究源于我们在成人稳定BE门诊患者管理方面的实际经验。我们记录了有关临床，放射学，微生物学和实验室特征的变量。我们确定了五种BE的病因学诊断（特发性，感染后，COPD，哮喘和非常见疾病[免疫缺陷或其他罕见疾病]）。使用多变量模型来确定每种病因诊断的预测因子。还考虑了对诊断进行特定测试的适用性。

结果

我们招募了354名新诊断为BE的患者。具有不同病因的患者在年龄，性别，吸烟习惯，合并症，呼吸困难知觉，气流阻塞和严重程度评分方面存在显着差异。评估了各种预测因素，包括性别，先前的呼吸道感染，BE的弥散性分布，风险评分和实验室变量（钠和嗜酸性粒细胞）。自身抗体或免疫球蛋白的水平保留用于诊断非常见疾病。

结论

我们的研究证实，某些预测因子是BE病因诊断的特异性指标。整合这些信息的可能性可能是诊断的有用工具。某些特定测试的执行应保留给非常见疾病患者。