Objective sputum colour assessment and clinical outcomes in bronchiectasis: data from the European Bronchiectasis Registry (EMBARC)
Stefano Aliberti, Felix C. Ringshausen, Raja Dhar, Charles Haworth, Michael R. Loebinger, Katerina Dimakou, Megan Crichton, Anthony De Soyza, Montserrat Vendrell, Pierre‐Régis Burgel, Melissa J. McDonnell, Sabina Škrgat, Luis Maiz Carro, A de Roux, Oriol Sibila, Apostolos Bossios, Menno M. van der Eerden, Paula Kauppi, Rob Wilson, Branislava Milenković, Rosario Menéndez, Marlène Murris, Şermin Börekçi, Oxana Munteanu, Dušanka Obradović, Adam Nowiński, Adelina Amorim, Antoní Torres, Natalie Lorent, Eva Van Braeckel, Josje Altenburg, Amelia Shoemark, Michal Shteinberg, Wim Boersma, Pieter Goeminne, J.S. Elborn, Adam T. Hill, Tobias Welte, Francesco Blasi, Eva Polverino, James D. Chalmers
Abstract
BACKGROUND: A validated 4-point sputum colour chart can be used to objectively evaluate the levels of airway inflammation in bronchiectasis patients. In the European Bronchiectasis Registry (EMBARC), we tested whether sputum colour would be associated with disease severity and clinical outcomes. METHODS: We used a prospective, observational registry of adults with bronchiectasis conducted in 31 countries. Patients who did not produce spontaneous sputum were excluded from the analysis. The Murray sputum colour chart was used at baseline and at follow-up visits. Key outcomes were frequency of exacerbations, hospitalisations for severe exacerbations and mortality during up to 5-year follow-up. RESULTS: ), worse quality of life, greater bacterial infection and a higher bronchiectasis severity index. Sputum colour was strongly associated with the risk of future exacerbations during follow-up. Compared to patients with mucoid sputum (reference group), patients with mucopurulent sputum experienced significantly more exacerbations (incident rate ratio (IRR) 1.29, 95% CI 1.22-1.38; p<0.0001), while the rates were even higher for patients with purulent (IRR 1.55, 95% CI 1.44-1.67; p<0.0001) and severely purulent sputum (IRR 1.91, 95% CI 1.52-2.39; p<0.0001). Hospitalisations for severe exacerbations were also associated with increasing sputum colour with rate ratios, compared to patients with mucoid sputum, of 1.41 (95% CI 1.29-1.56; p<0.0001), 1.98 (95% CI 1.77-2.21; p<0.0001) and 3.05 (95% CI 2.25-4.14; p<0.0001) for mucopurulent, purulent and severely purulent sputum, respectively. Mortality was significantly increased with increasing sputum purulence, hazard ratio 1.12 (95% CI 1.01-1.24; p=0.027), for each increment in sputum purulence. CONCLUSION: Sputum colour is a simple marker of disease severity and future risk of exacerbations, severe exacerbations and mortality in patients with bronchiectasis.