Abstract / Summary
Abstract Background Bronchiectasis is a chronic and heterogeneous airway disease characterized by recurrent infections, persistent inflammation, and progressive lung damage. Identifying factors associated with mortality is essential for improving patient outcomes. This multicenter study aimed to evaluate etiological, clinical, microbiological, and inflammatory characteristics and to determine predictors of mortality in patients with non-cystic fibrosis bronchiectasis in Türkiye. Methods This retrospective, observational study included 479 adult patients with radiologically confirmed non-cystic fibrosis bronchiectasis from five tertiary care centers. We retrieved demographic, clinical, microbiological, and laboratory data from hospital records and the national health database. Systemic inflammatory markers, including the neutrophil-to-lymphocyte ratio (NLR) and systemic immune-inflammation index (SII), were calculated. Univariate and multivariate logistic regression analyses were performed to identify independent predictors of mortality. Receiver operating characteristic (ROC) analysis was used to assess the predictive performance of inflammatory markers. Results The mean age of the cohort was 58.47 ± 15.76 years, and 52.2% of the patients were female. During the follow-up period, mortality occurred in 61 patients (12.7%), predominantly due to respiratory failure and pulmonary infections. Non-survivors were significantly older, presented with higher mMRC dyspnea scores, and exhibited more severely impaired pulmonary function (p < 0.001 and p = 0.006, respectively). Healthcare utilization parameters, including emergency department visits, hospitalizations, and intensive care unit (ICU) admissions, were markedly higher among non-survivors (all p < 0.001). Sputum culture positivity and chronic Pseudomonas aeruginosa isolation were significantly more frequent in the mortality group (p < 0.001). Inflammatory markers, namely NLR and SII, were also significantly elevated in patients who died (p < 0.001 and p = 0.001, respectively). In multivariate analysis, reduced FEV1 (OR: 0.242, p = 0.049) and prior ICU admission (OR: 12.788, p < 0.001) emerged as independent predictors of mortality. ROC analysis demonstrated modest predictive performance for NLR (cut-off: 3.99, AUC: 0.637) and SII (cut-off: 1183.03, AUC: 0.626). Conclusion Reduced pulmonary function and prior ICU admissions are independent predictors of mortality in non-cystic fibrosis bronchiectasis. Chronic airway colonization with Pseudomonas aeruginosa and elevated systemic inflammatory markers contribute significantly to adverse clinical outcomes. These findings highlight the necessity of comprehensive etiological screening, early microbiological evaluation, and rigorous risk stratification in clinical practice.