Abstract
BackgroundChronic obstructive pulmonary disease (COPD) is a major comorbid disease of Mycobacterium avium complex pulmonary disease (MAC-PD). Emphysema is one of the main pathological findings in COPD, a risk factor for chronic pulmonary aspergillosis (CPA), and is associated with poor prognosis. We aimed to clarify the effect of emphysema on mortality in MAC-PD. MethodsWe retrospectively analyzed 203 patients with MAC-PD at The Jikei Daisan Hospital between January 2014 and December 2018. We investigated the mortality and CPA development rates after MAC-PD diagnosis in patients with or without emphysema. ResultsMultivariate Cox proportional hazards regression analysis showed the following negative prognostic factors in patients with MAC-PD: emphysema (hazard ratio [HR]: 11.46; 95% confidence interval [CI]: 1.30–100.90; P = 0.028); cavities (HR: 3.12; 95% CI: 1.22–7.94; P = 0.017); and low body mass index (<18.5 kg/m2) (HR: 4.62; 95% CI: 1.63–13.11; P = 0.004). The mortality and occurrence of CPA were higher in MAC-PD patients with than without emphysema (log-rank test, P < 0.0001 and P < 0.0001). ConclusionOur study findings showed that emphysema detected by computed tomography was associated with an increased risk of CPA development and mortality in MAC-PD.
Highlights
Non-tuberculous mycobacterial pulmonary disease (NTM-PD) is increasing worldwide [1,2]
We evaluated the impact of computed tomography (CT)-detected emphysema on clinical characteristics and mortality in patients with Mycobacterium avium complex pulmonary disease (MAC-PD) at our hospital
We demonstrated that CT detection of emphysema is a robust predictor of mortality in patients with Mycobacterium avium complex (MAC)-PD
Summary
Non-tuberculous mycobacterial pulmonary disease (NTM-PD) is increasing worldwide [1,2]. With the increase in NTM-PD, comorbid lung diseases, including chronic obstructive pul monary disease (COPD), have been reported to influence its clinical features [9]. Emphy sema and MAC-PD are risk factors for chronic pulmonary aspergillosis (CPA), and CPA is strongly associated with poor prognosis [16,17,18]. Emphysema is one of the main pathological findings in COPD, a risk factor for chronic pulmonary aspergillosis (CPA), and is associated with poor prognosis. We investigated the mortality and CPA development rates after MAC-PD diagnosis in patients with or without emphysema. Conclusion: Our study findings showed that emphysema detected by computed tomography was associated with an increased risk of CPA development and mortality in MAC-PD
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