Abstract
BackgroundPatients with Mycobacterium avium complex (MAC) lung disease (LD) have a heterogeneous prognosis. This study aimed to develop and validate a prognostic scoring model for these patients using independent risk factors for survival.MethodsWe retrospectively analyzed the data of patients with MAC-LD from two hospitals (cohort 1, n = 368; cohort 2, n = 118). Cohort 1 was evaluated using a multivariate Cox proportional hazards model to identify independent risk factors for overall survival (OS). A prognostic scoring model composed of these factors was developed, and cohort 1 was stratified into three groups according to risk using the log-rank test. Finally, the prognostic scoring model was validated using the data of cohort 2.ResultsSeven independent risk factors for OS were selected from cohort 1, including the male sex, age ≥ 70 years, the presence of a malignancy, body mass index <18.5 kg/m2, lymphocyte count <1000 cells/μL, serum albumin levels <3.5 g/dL, and fibrocavitary disease. The areas under the receiver operating characteristic curves for the prognostic scoring model were 0.84 [95% confidence interval (CI), 0.80 − 0.89] for cohort 1 and 0.84 (95% CI, 0.75 − 0.92) for cohort 2. The 5-year OS rates of patients stratified into low-risk, intermediate-risk, and high-risk groups were 97.6, 76.6, and 30.8%, respectively (P < 0.001), in cohort 1, and 97.2, 82.3, and 45.4%, respectively (P < 0.001), in cohort 2.ConclusionsThis study is the first to develop and validate a prognostic scoring model for patients with MAC-LD. This model may prove useful in clinical settings and practical in estimating the prognosis.
Highlights
Patients with Mycobacterium avium complex (MAC) lung disease (LD) have a heterogeneous prognosis
Several factors are reported to be associated with the prognosis of MAC-LD [5], information regarding the prognosis of MAC-LD remains scarce
Patients This study retrospectively reviewed patients aged >18 years who were newly diagnosed with MAC-LD according to the 2007 ATS/IDSA diagnostic criteria [1] between January 2006 and December 2011 at Kurashiki Central Hospital and Kitano Hospital
Summary
Patients with Mycobacterium avium complex (MAC) lung disease (LD) have a heterogeneous prognosis. This study aimed to develop and validate a prognostic scoring model for these patients using independent risk factors for survival. The Mycobacterium avium complex (MAC), including M. avium and M. intracellulare, is the most common cause of chronic respiratory infections among the NTM species [1,2,3,4]. A prognostic scoring model involving prognostic factors of MAC-LD identified at diagnosis could aid physicians in the prediction of the overall survival (OS) or MAC-specific survival. The purpose of this study was to identify prognostic factors at diagnosis associated with the OS of patients with MACLD, and to develop and validate a new prognostic scoring model stratifying the long-term outcomes of MAC-LD
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