C27-04 Bronchiectasis Complicated by Pulmonary Aspergillosis: A Multicenter Study on Prognosis and Risk Factors

Abstract 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 in patients with bronchiectasis, and identify potential factors linked to aspergillosis complication. Methods We reviewed the medical records of 899 bronchiectasis patients from four tertiary hospitals. We identified 62 patients who were diagnosed with pulmonary aspergillosis (PA), encompassing 11 cases of invasive pulmonary aspergillosis (IPA) and 51 cases of chronic pulmonary aspergillosis (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 (13.2% 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-month and 12-month follow-up and patients with PA had a higher one-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 as independent risk factors for the development of PA. Conclusion PA is frequent in bronchiectasis and associated with a poorer prognosis. Cavities on HRCT and prior pulmonary tuberculosis are significant risk factors for PA in these patients. This abstract is funded by: Project of Natural Science Foundation of China (Nos. 82570016 and 82270019), the National Science and Technology Major Project (No. 2024ZD0522500), and the General Program of Clinical Research, Nanjing Drum Tower Hospital (No. 2023-LCYJ-MS-18)