Bronchiectasis complicated by pulmonary aspergillosis: a multicenter study on prognosis and risk factors.

Background: Aspergillus-related pulmonary diseases are frequent in bronchiectasis patients due to the impaired mucociliary clearance. However, research on the characteristics and factors of aspergillosis in patients with bronchiectasis is limited. The study aims to assess the prevalence and characteristics of pulmonary aspergillosis (PA) in patients with bronchiectasis, and identify potential factors linked to aspergillosis complications. Methods: We reviewed the medical records of 899 bronchiectasis patients from four tertiary hospitals. We identified 62 patients who were diagnosed with PA, encompassing 11 cases of invasive PA (IPA) and 51 cases of chronic PA (CPA). They were compared with 241 controls without aspergillosis. Results: Bronchiectasis patients with PA exhibited a significantly higher frequency of exacerbations (P=0.001) and hospitalizations (P=0.001) in the preceding year compared to those without PA. Chest high-resolution computed tomography (HRCT) scans revealed that patients with PA exhibited a greater prevalence of consolidation/infiltrates, cavities, nodular shadows, and pleural thickening. Moreover, a higher proportion of patients in the PA group had undergone lobectomy (11.3% vs. 0%). The in-hospital mortality rate was also higher in the PA group (4.8% vs. 0.4%). In terms of post-discharge outcomes, the PA group had more hospitalizations at both the 6- and 12-month follow-up, and patients with PA had a higher 1-year mortality rate after discharge (11.3% vs. 3.5%). Multivariate analysis identified the presence of cavities on chest HRCT and a previous history of pulmonary tuberculosis (TB) as independent risk factors for the development of PA. Conclusions: PA is frequent in bronchiectasis and associated with a poorer prognosis. Cavities on HRCT and prior pulmonary TB are significant risk factors for PA in these patients.