Abstract
BackgroundThe incidence of nontuberculous mycobacterial (NTM) pulmonary disease caused by Mycobacterium avium complex (MAC) in apparently immune-competent people is increasing worldwide. We performed a systematic review of the published literature on five-year all-cause mortality in patients with MAC lung disease, and pooled the mortality rates to give an overall estimate of five-year mortality from these studies.MethodsWe systematically reviewed the literature up to 1st August 2017 using PubMed® and ProQuest Dialog™ to search Medline® and Embase® databases, respectively. Eligible studies contained > 10 patients with MAC, and numerical five-year mortality data or a treatment evaluation for this patient group. Mortality data were extracted and analysed to determine a pooled estimate of all-cause mortality.ResultsFourteen of 1035 identified studies, comprising 17 data sets with data from a total of 9035 patients, were eligible. The pooled estimate of five-year all-cause mortality was 27% (95% CI 21.3–37.8%). A high degree of heterogeneity was observed (I2 = 96%). The mortality in the data sets varied between 10 and 48%. Studies predominantly including patients with cavitary disease or greater comorbidity reported a higher risk of death. Patients in Asian studies tended to have a lower mortality risk. Predictors of mortality consistent across studies included male sex, presence of comorbidities and advanced patient age.ConclusionsDespite high heterogeneity, most studies in patients with MAC pulmonary disease document a five-year all-cause mortality exceeding 25%, indicating poor prognosis. These findings emphasise the need for more effective management and additional prospective mortality data collection.
Highlights
The incidence of nontuberculous mycobacterial (NTM) pulmonary disease caused by Mycobacterium avium complex (MAC) in apparently immune-competent people is increasing worldwide
Two studies examined patients with other NTM infections [20, 21], and one investigated nodular/bronchiectatic MAC lung disease [18]
Two of the included studies covered NTM pulmonary disease (NTM-PD), the majority of the patients in these studies were diagnosed with MAC lung disease [22, 23]
Summary
The incidence of nontuberculous mycobacterial (NTM) pulmonary disease caused by Mycobacterium avium complex (MAC) in apparently immune-competent people is increasing worldwide. NTM are thought of as opportunistic pathogens, with disseminated NTM disease being seen in patients with systemic impaired immunity (e.g. HIV) [2, 3]. Interest in NTM pulmonary disease (NTM-PD) is increasing due to its growing prevalence in non-HIV populations [2]. It can occur in the context of lung disease caused by, for example, bronchiectasis, chronic obstructive. NTM-PD symptoms are nonspecific and variable; patients may present with both respiratory and systemic complaints, which may relate to underlying lung disease [2]. NTM-PD diagnosis is generally made when the American Thoracic Society/Infectious Diseases Society of America (ATS/ IDSA) diagnostic criteria are met [2]
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