Geo-economic variations in epidemiology, patterns of care, and outcomes in patients with acute respiratory distress syndrome: insights from the LUNG SAFE prospective cohort study

John G Laffey, Fabiana Madotto, Giacomo Bellani, Tài Pham, Eddy Fan, Laurent Brochard, Pravin Amin, Yaseen Arabi, Ednan K Bajwa, Alejandro Bruhn, Vladimir Cerny, Kevin Clarkson, Leo Heunks, Kiyoyasu Kurahashi, Jon Henrik Laake, Jose A Lorente, Lia McNamee, Nicolas Nin, Jose Emmanuel Palo, Lise Piquilloud, Haibo Qiu, Juan Ignacio Silesky Jiménez, Andres Esteban, Daniel F McAuley, Frank van Haren, Marco Ranieri, Gordon Rubenfeld, Hermann Wrigge, Arthur S Slutsky, Antonio Pesenti, John G. Laffey, Giacomo Bellani, Tai Pham, Eddy Fan, Laurent Brochard, Antonio Pesenti, Andres Esteban, Luciano Gattinoni, Frank van Haren, Anders Larsson, Daniel F. McAuley, Marco Ranieri, Gordon Rubenfeld, B Taylor Thompson, Hermann Wrigge, Arthur S. Slutsky, Fernando Rios, Thierry Sottiaux, Pieter Depuydt, Fredy S Lora, Luciano C Azevedo, Guillermo Bugedo, Haibo Qiu, Marcos Gonzalez, Juan Silesky, Vladimir Cerny, Jonas Nielsen, Manuel Jibaja, Hermann Wrigge, Dimitrios Matamis, Jorge L. Ranero, Pravin Amin, S.M. Hashemian, Kevin Clarkson, Kiyoyasu Kurahashi, Asisclo Villagomez, Amine Ali Zeggwagh, Leo M Heunks, Jon Henrik Laake, Jose Emmanuel Palo, Antero do Vale Fernandes, Dorel Sandesc, Yaasen Arabi, Vesna Bumbasierevic, Nicolas Nin, Jose A. Lorente, Anders Larsson, Lise Piquilloud, Fekri Abroug, Lia McNamee, Javier Hurtado, Ed Bajwa, Gabriel Démpaire, Hektor Sula, Lordian Nunci, Alma Cani, Alan Zazu, Christian Dellera, Risso V Alejandro, Julio Daldin, Ruben O Fernandez, Luis P Cardonnet, Lisandro R. Bettini, Mariano Carboni Bisso, Emilio M. Osman, Mariano G. Setten, Pablo Lovazzano, Javier Alvarez, Veronica Villar, Norberto C. Pozo, Nicolas Grubissich, Gustavo A. Plotnikow, Daniela N. Vasquez, Santiago Ilutovich, Norberto Tiribelli, Ariel Chena, Carlos A. Pellegrini, María G. Saenz, Elisa Estenssoro, Matias Brizuela, Hernan Gianinetto, Pablo E. Gomez, Valeria I. Cerrato, Marco G. Bezzi, Silvina A. Borello, Flavia A. Loiacono, Adriana M. Fernandez, Serena Knowles, Claire Reynolds, Deborah M. Inskip, Jennene J Miller, Jing Kong, Christina Whitehead, Shailesh Bihari, Aylin Seven, Amanda Krstevski, Helen Rodgers, Rebecca Millar, Toni Mckenna, Irene Bailey, Gabrielle Hanlon, Anders Aneman, Joan Lynch, Raman Azad, John Neal, Paul Woods, Brigit Roberts, Mark Kol, Helen Wong, Katharina Riss, Thomas Staudinger, Xavier Wittebole, Caroline Berghe, Pierre Bulpa, Alain Dive, Rik Verstraete, Herve Lebbinck, Joris Vermassen, Philippe Meersseman, Helga Ceunen, Jonas Rosa, Daniel Beraldo, Claudio Piras, Adenilton Rampinelli, Antonio Nassar, Sergio Mataloun, Marcelo Moock, Marlus Thompson, Claudio Gonçalves, Ana Antônio, Aline Ascoli, Rodrigo Biondi, Danielle Fontenele, Danielle Nobrega, Vanessa Sales, Suresh Shindhe, Dk Ismail, Francois Beloncle, Kyle Davies, Rob Cirone, Venika Manoharan, Mehvish Ismail, Ewan Goligher, Mandeep Jassal, Erin Nishikawa, Areej Javeed, Gerard Curley, Nuttapol Rittayamai, Matteo Parotto, Niall Ferguson, Sangeeta Mehta, Jenny Knoll, Antoine Pronovost, Sergio Canestrini, Alejandro Bruhn, Patricio Garcia, Felipe Aliaga, Pamela Farías, Jacob Yumha, Claudia Ortiz, Javier Salas, Alejandro Saez, Luis Vega, Eduardo Labarca, Felipe Martinez, Nicolás Carreño, Pilar Lora, Haitao Liu, Haibo Qiu, Ling Liu, Rui Tang, Xiaoming Luo, Youzhong An, Huiying Zhao, Yan Gao, Zhe Zhai, Zheng Ye, Wei Wang, Wenwen Li, Qingdong Li, Ruiqiang Zheng, Wenkui Yu, Juanhong Shen, Xinyu Li, Tao Yu, Weihua Lu, Ya Wu, Xiao Huang, Zhenyang He, Yuanhua Lu, Hui Han, Fan Zhang, Renhua Sun, Hua Wang, Shu Qin, Bao Zhu, Jun Zhao, Jian Liu, Bin Li, Jing Liu, Fa Zhou, Qiong Li, Xing Zhang, Zhou Li-Xin, Qiang Xin-Hua, Liangyan Jiang, Yuan Gao, Xian Zhao, Yuan Li, Xiao Li, Chunting Wang, Qingchun Yao, Rongguo Yu, Kai Chen, Huanzhang Shao, Bingyu Qin, Qing Huang, Wei Zhu, Ai Hang, Ma Hua, Yimin Li, Yonghao Xu, Yu Di, Long Ling, Tie Qin, Shou Wang, Junping Qin, Yi Han, Suming Zhou, Monica Vargas, Juan Jimenez, Manuel Rojas, Jaime Solis-Quesada, Christian Ramirez-Alfaro, Jan Máca, Peter Sklienka, Jakob Gjedsted, Aage Christiansen, Jonas Nielsen, Boris Villamagua, Miguel Llano, Philippe Burtin, Gautier Buzancais, Pascal Beuret, Nicolas Pelletier, Satar Mortaza, Alain Mercat, Jonathan Chelly, Sébastien Jochmans, Nicolas Terzi, Cédric Daubin, Guillaume Carteaux, Nicolas de Prost, Jean-Daniel Chiche, Fabrice Daviaud, Tai Pham, Muriel Fartoukh, Guillaume Barberet, Jerome Biehler, Jean Dellamonica, Denis Doyen, Jean-Michel Arnal, Anais Briquet, Sami Hraiech, Laurent Papazian, Damien Roux, Jonathan Messika, Evangelos Kalaitzis, Laurence Dangers, Alain Combes, Siu-Ming Au, Gaetan Béduneau, Dorothée Carpentier, Elie Zogheib, Herve Dupont, Sylvie Ricome, Francesco Santoli, Sebastien Besset, Philippe Michel, Bruno Gelée, Pierre-Eric Danin, Bernard Goubaux, Philippe Crova, Nga Phan, Frantz Berkelmans, Julio Badie, Romain Tapponnier, Josette Gally, Samy Khebbeb, Jean-Etienne Herbrecht, Francis Schneider, Pierre-Louis Declercq, Jean-Philippe Rigaud, Jacques Duranteau, Anatole Harrois, Russell Chabanne, Julien Marin, Charlene Bigot, Sandrine Thibault, Mohammed Ghazi, Messabi Boukhazna, Salem Zein, Jack Richecoeur, Daniele Combaux, Fabien Grelon, Charlene Le Moal, Elise Sauvadet, Adrien Robine, Virginie Lemiale, Danielle Reuter, Martin Dres, Alexandre Demoule, Dany Goldgran-Toledano, Loredana Baboi, Claude Guérin, Ralph Lohner, Jens Kraßler, Susanne Schäfer, Kai Zacharowski, Patrick Meybohm, Andreas Reske, Philipp Simon, Hans-Bernd Hopf, Michael Schuetz, Thomas Baltus, Metaxia Papanikolaou, Theonymfi Papavasilopoulou, Giannis Zacharas, Vasilis Ourailogloy, Eleni Mouloudi, Eleni Massa, Eva Nagy, Electra Stamou, Ellada Kiourtzieva, Marina Oikonomou, Luis Avila, Cesar Cortez, Johanna Citalán, Sameer Jog, Safal Sable, Bhagyesh Shah, Mohan Gurjar, Arvind Baronia, Mohammedfaruk Memon, Radhakrishnan Muthuchellappan, Venkatapura Ramesh, Anitha Shenoy, Ramesh Unnikrishnan, Subhal Dixit, Rachana Rhayakar, Nagarajan Ramakrishnan, Vallish Bhardwaj, Heera Mahto, Sudha Sagar, Vijayanand Palaniswamy, Deeban Ganesan, Seyed Hashemian, Hamidreza Jamaati, Farshad Heidari, Edel Meaney, Alistair Nichol, Karl Knapman, Donall O'Croinin, Eimhin Dunne, Dorothy Breen, Kevin Clarkson, Rola Jaafar, Rory Dwyer, Fahd Amir, Olaitan Ajetunmobi, Aogan O'Muircheartaigh, Colin Black, Nuala Treanor, Daniel Collins, Wahid Altaf, Gianluca Zani, Maurizio Fusari, Savino Spadaro, Carlo Volta, Romano Graziani, Barbara Brunettini, Salvatore Palmese, Paolo Formenti, Michele Umbrello, Andrea Lombardo, Elisabetta Pecci, Marc Botteri, Monica Savioli, Alessandro Protti, Alessia Mattei, Lorenzo Schiavoni, Andrea Tinnirello, Manuel Todeschini, Antonino Giarratano, Andrea Cortegiani, Sara Sher, Anna Rossi, Massimo Antonelli, Luca Montini, Paolo Casalena, Sergio Scafetti, Giovanna Panarello, Giovanna Occhipinti, Nicolò Patroniti, Matteo Pozzi, Roberto Biscione, Michela Poli, Ferdinando Raimondi, Daniela Albiero, Giulia Crapelli, Eduardo Beck, Vincenzo Pota, Vincenzo Schiavone, Alexandre Molin, Fabio Tarantino, Giacomo Monti, Elena Frati, Lucia Mirabella, Gilda Cinnella, Tommaso Fossali, Riccardo Colombo, Pierpaolo Terragni, Ilaria Pattarino, Francesco Mojoli, Antonio Braschi, Erika Borotto, Andrea Cracchiolo, Daniela Palma, Francesco Raponi, Giuseppe Foti, Ettore Vascotto, Andrea Coppadoro, Luca Brazzi, Leda Floris, Giorgio Iotti, Aaron Venti, Osamu Yamaguchi, Shunsuke Takagi, Hiroki Maeyama, Eizo Watanabe, Yoshihiro Yamaji, Kazuyoshi Shimizu, Kyoko Shiozaki, Satoru Futami, Sekine Ryosuke, Koji Saito, Yoshinobu Kameyama, Keiko Ueno, Masayo Izawa, Nao Okuda, Hiroyuki Suzuki, Tomofumi Harasawa, Michitaka Nasu, Tadaaki Takada, Fumihito Ito, Shin Nunomiya, Kansuke Koyama, Toshikazu Abe, Kohkichi Andoh, Kohei Kusumoto, Akira Hirata, Akihiro Takaba, Hiroyasu Kimura, Shuhei Matsumoto, Ushio Higashijima, Hiroyuki Honda, Nobumasa Aoki, Hiroshi Imai, Yasuaki Ogino, Ichiko Mizuguchi, Kazuya Ichikado, Kenichi Nitta, Katsunori Mochizuki, Tomoaki Hashida, Hiroyuki Tanaka, Tomoyuki Nakamura, Daisuke Niimi, Takeshi Ueda, Yozo Kashiwa, Akinori Uchiyama, Olegs Sabelnikovs, Peteris Oss, Youssef Haddad, Kong Liew, Silvio Ñamendys-Silva, Yves Jarquin-Badiola, Luis Sanchez-Hurtado, Saira Gomez-Flores, Maria Marin, Asisclo Villagomez, Jordana Lemus, Jonathan Fierro, Mavy Cervantes, Francisco Mejia, Dulce M. Dector, Daniel Gonzalez, Claudia Estrella, Jorge Sanchez-Medina, Alvaro Ramirez-Gutierrez, Fernando George, Janet Aguirre, Juan Buensuseso, Manuel Poblano, Tarek Dendane, Amine Zeggwagh, Hicham Balkhi, Mina Elkhayari, Nacer Samkaoui, Hanane Ezzouine, Abdellatif Benslama, Mourad Amor, Wajdi Maazouzi, Nedim Cimic, Oliver Beck, Monique Bruns, Jeroen Schouten, Myra Rinia, Monique Raaijmakers, Leo Heunks, Hellen Van Wezel, Serge Heines, Ulrich Strauch, Fabienne Simonis, Jennifer Goodson, Troy Browne, Leanlove Navarra, Anna Hunt, Robyn Hutchison, Mathew Bailey, Lynette Newby, Colin Mcarthur, Michael Kalkoff, Alex Mcleod, Jonathan Casement, Danielle Hacking, Finn Andersen, Merete Dolva, Jon Laake, Andreas Barratt-Due, Kim Noremark, Eldar Søreide, Brit Sjøbø, Anne Guttormsen, Hector Yoshido, Ronald Aguilar, Fredy Oscanoa, Alain Alisasis, Joanne Robles, Rossini Pasanting-Lim, Beatriz Tan, Pawel Andruszkiewicz, Karina Jakubowska, Cristina Coxo, António Alvarez, Bruno Oliveira, Gustavo Montanha, Nelson Barros, Carlos Pereira, António Messias, Jorge Monteiro, Ana Araujo, Nuno Catorze, Susan Marum, Maria Bouw, Rui Gomes, Vania Brito, Silvia Castro, Joana Estilita, Filipa Barros, Isabel Serra, Aurelia Martinho, Dana Tomescu, Alexandra Marcu, Ovidiu Bedreag, Marius Papurica, Dan Corneci, Silvius Negoita, Evgeny Grigoriev, Alexey Gritsan, Andrey Gazenkampf, Ghaleb Almekhlafi, Mohamad Albarrak, Ghanem Mustafa, Khalid Maghrabi, Nawal Salahuddin, Tharwat Aisa, Ahmed Al Jabbary, Edgardo Tabhan, Yaseen Arabi, Olivia Trinidad, Hasan Al Dorzi, Edgardo Tabhan, Stefan Bolon, Oliver Smith, Jordi Mancebo, Hernan Aguirre-Bermeo, Juan Lopez-Delgado, Francisco Esteve, Gemma Rialp, Catalina Forteza, Candelaria De Haro, Guillermo Albaiceta, Sara De Cima-Iglesias, Leticia Seoane-Quiroga, Alexandra Ceniceros-Barros, Antonio Ruiz-Aguilar, Luis Claraco-Vega, Juan Soler, Maria del Carmen Lorente, Cecilia Hermosa, Federico Gordo, Miryam Prieto-González, Juan López-Messa, Manuel Perez, Cesar Perez, Raquel Allue, Ferran Roche-Campo, Marcos Ibañez-Santacruz, Susana Temprano, Maria Pintado, Raul De Pablo, Pilar Gómez, Silvia Ruiz, Silvia Moles, Teresa Jurado, Alfons Arizmendi, Enrique Piacentini, Nieves Franco, Teresa Honrubia, Meisy Cheng, Elena Losada, Javier Blanco, Luis Yuste, Cecilia Carbayo-Gorriz, Francisca Cazorla-Barranquero, Javier Alonso, Rosa Alda, Ángela Algaba, Gonzalo Navarro, Enrique Cereijo, Esther Diaz-Rodriguez, Diego Marcos, Laura Montero, Luis Para, Roberto Sanchez, Miguel Navalpotro, Ricardo Abad, Raquel González, Dácil Toribio, Alejandro Castro, Maria Artiga, Oscar Penuelas, Tomas Roser, Moreno Olga, Elena Curto, Rocío Sánchez, Vallverdu Imma, Garcia Elisabet, Laura Claverias, Monica Magret, Ana Pellicer, Lucia Rodriguez, Jesús Sánchez-Ballesteros, Ángela González-Salamanca, Antonio Jimenez, Francisco Huerta, Juan Diaz, Esther Lopez, David Moya, Alec Alfonso, Palazon Luis, Palazon Cesar, Sánchez Rafael, Corcoles Virgilio, Noelia Recio, Richard Adamsson, Christian Rylander, Bernhard Holzgraefe, Lars Broman, Joanna Wessbergh, Linnea Persson, Fredrik Schiöler, Hans Kedelv, Anna Tibblin, Henrik Appelberg, Lars Hedlund, Johan Helleberg, Karin Eriksson, Rita Glietsch, Niklas Larsson, Ingela Nygren, Silvia Nunes, Anna-Karin Morin, Thomas Kander, Anne Adolfsson, Lise Piquilloud, Hervé Zender, Corinne Leemann-Refondini, Souheil Elatrous, Slaheddine Bouchoucha, Imed Chouchene, Islem Ouanes, Asma Souissi, Salma Kamoun, Oktay Demirkiran, Mustafa Aker, Emre Erbabacan, Ilkay Ceylan, Nermin Girgin, Menekse Ozcelik, Necmettin Ünal, Basak Meco, Onat Akyol, Suleyman Derman, Barry Kennedy, Ken Parhar, Latha Srinivasa, Lia McNamee, Danny McAuley, Phil Hopkins, Clare Mellis, Vivek Kakar, Dan Hadfield, Andre Vercueil, Kaushik Bhowmick, Sally Humphreys, Andrew Ferguson, Raymond Mckee, Ashok Raj, Danielle Fawkes, Philip Watt, Linda Twohey, Rajeev Jha, Matthew Thomas, Alex Morton, Varsha Kadaba, Mark Smith, Anil Hormis, Santhana Kannan, Miriam Namih, Henrik Reschreiter, Julie Camsooksai, Alek Kumar, Szabolcs Rugonfalvi, Christopher Nutt, Orla O'Neill, Colette Seasman, Ged Dempsey, Christopher Scott, Helen Ellis, Stuart MckKechnie, Paula Hutton, Nora Di Tomasso, Michela Vitale, Ruth Griffin, Michael Dean, Julius Cranshaw, Emma Willett, Nicholas Ioannou, Sarah Gillis, Peter Csabi, Rosaleen Macfadyen, Heidi Dawson, Pieter Preez, Alexandra Williams, Owen Boyd, Laura De Gordoa, Jon Bramall, Sophie Symmonds, Simon Chau, Tim Wenham, Tamas Szakmany, Piroska Toth-Tarsoly, Katie McCalman, Peter Alexander, Lorraine Stephenson, Thomas Collyer, Rhiannon Chapman, Raphael Cooper, Russell Allan, Malcolm Sim, David Wrathall, Donald Irvine, Kim Zantua, John Adams, Andrew Burtenshaw, Gareth Sellors, Ingeborg Welters, Karen Williams, Robert Hessell, Matthew Oldroyd, Ceri Battle, Suresh Pillai, Istvan Kajtor, Mageswaran Sivashanmugavel, Sinead O'Kane, Adrian Donnelly, Aniko Frigyik, Jon Careless, Martin May, Richard Stewart, T. John Trinder, Samantha Hagan, Matt Wise, Jade Cole, Caroline MacFie, Anna Dowling, Javier Hurtado, Nicolás Nin, Edgardo Nuñez, Gustavo Pittini, Ruben Rodriguez, María Imperio, Cristina Santos, Ana França, Alejandro Ebeid, Alberto Deicas, Carolina Serra, Aditya Uppalapati, Ghassan Kamel, Valerie Banner-Goodspeed, Jeremy Beitler, Satyanarayana Mukkera, Shreedhar Kulkarni, Jarone Lee, Tomaz Mesar, John Shinn, Dina Gomaa, Christopher Tainter, Jarone Lee, Tomaz Mesar, Jarone Lee, Dale Yeatts, Jessica Warren, Michael Lanspa, Russel Miller, Colin Grissom, Samuel Brown, Philippe Bauer, Ryan Gosselin, Barrett Kitch, Jason Cohen, Scott Beegle, Renaud Gueret, Aiman Tulaimat, Shazia Choudry, William Stigler, Hitesh Batra, Nidhi Huff, Keith Lamb, Trevor Oetting, Nicholas Mohr, Claine Judy, Shigeki Saito, Fayez Kheir, Fayez Kheir, Adam Schlichting, Angela Delsing, Daniel Crouch, Mary Elmasri, Daniel Crouch, Dina Ismail, Kyle Dreyer, Thomas Blakeman, Kyle Dreyer, Dina Gomaa, Rebecca Baron, Carolina Grijalba, Peter Hou, Raghu Seethala, Imo Aisiku, Galen Henderson, Sen-Kuang Hou, Robert Owens, Ashley Schomer, Vesna Bumbasirevic, Bojan Jovanovic, Maja Surbatovic, Milic Veljovic

Patients with bronchiectasis often have concurrent comorbidities, but the nature, prevalence, and impact of these comorbidities on disease severity and outcome are poorly understood. We aimed to investigate comorbidities in patients with bronchiectasis and establish their prognostic value on disease severity and mortality rate. An international multicentre cohort analysis of outpatients with bronchiectasis from four European centres followed up for 5 years was done for score derivation. Eligible patients were those with bronchiectasis confirmed by high-resolution CT and a compatible clinical history. Comorbidity diagnoses were based on standardised definitions and were obtained from full review of paper and electronic medical records, prescriptions, and investigator definitions. Weibull parametric survival analysis was used to model the prediction of the 5 year mortality rate to construct the Bronchiectasis Aetiology Comorbidity Index (BACI). We tested the BACI as a predictor of outcomes and explored whether the BACI added further prognostic information when used alongside the Bronchiectasis Severity Index (BSI). The BACI was validated in two independent international cohorts from the UK and Serbia. Between June 1, 2006, and Nov 22, 2013, 1340 patients with bronchiectasis were screened and 986 patients were analysed. Patients had a median of four comorbidities (IQR 2-6; range 0-20). 13 comorbidities independently predicting mortality rate were integrated into the BACI. The overall hazard ratio for death conferred by a one-point increase in the BACI was 1·18 (95% CI 1·14-1·23; p<0·0001). The BACI predicted 5 year mortality rate, hospital admissions, exacerbations, and health-related quality of life across all BSI risk strata (p<0·0001 for mortality and hospital admissions, p=0·03 for exacerbations, p=0·0008 for quality of life). When used in conjunction with the BSI, the combined model was superior to either model alone (p=0·01 for combined vs BACI; p=0·008 for combined vs BSI). Multimorbidity is frequent in bronchiectasis and can negatively affect survival. The BACI complements the BSI in the assessment and prediction of mortality and disease outcomes in patients with bronchiectasis. European Bronchiectasis Network (EMBARC).