Prognostic Factors of 634 HIV-negative Patients With Mycobacterium Avium Complex Lung Disease

Am J Respir Crit Care Med. 2012 Mar 1;185(5):575-83. doi: 10.1164/rccm.201107-1203OC. Epub 2011 Dec 28.

Abstract

Rationale: The prognostic factors of Mycobacterium avium complex lung disease (MAC-LD) are not clearly defined.

Objectives: To assess the prognostic factors of all-cause and MAC-specific mortality in patients with MAC-LD, especially in accordance with radiographic features, first-line treatment, and host predisposition.

Methods: Medical records of 634 HIV-negative patients with MAC-LD treated at our institution in Saitama, Japan were retrospectively analyzed.

Measurements and main results: Patients' mean age was 68.9 years, and median follow-up period was 4.7 years. Radiographic features included nodular/bronchiectatic (NB) disease: 482 patients (76.0%); fibrocavitary (FC) disease: 105 patients (16.6%); FC+NB disease: 30 patients (4.7%); and other types: 17 patients (3.0%). First-line treatments were observation or one drug: 479 patients (75.6%); 2 to 5 drugs: 131 patients (20.7%); and unknown: 24 patients (3.8%). A multivariate Cox proportional hazard model showed male sex, older age, presence of systemic and/or respiratory comorbidity, non-NB radiographic features, body mass index (BMI) less than 18.5 kg/m(2), anemia, hypoalbuminemia, and erythrocyte sedimentation rate greater than or equal to 50 mm/h to be negative prognostic factors for all-cause mortality, and FC or FC+NB radiographic features, BMI less than 18.5 kg/m(2), anemia, and C-reactive protein greater than or equal to 1.0 mg/dl to be negative prognostic factors for MAC-specific mortality.

Conclusions: The first-line treatment regimen was not associated with all-cause mortality. FC or FC+NB disease, BMI less than 18.5 kg/m(2), and anemia were negative prognostic factors for both all-cause and MAC-specific mortality.

MeSH terms

  • Age Factors
  • Aged
  • Anti-Bacterial Agents / therapeutic use
  • Female
  • HIV Seronegativity
  • Humans
  • Kaplan-Meier Estimate
  • Lung / diagnostic imaging
  • Lung / microbiology
  • Lung Diseases / diagnosis
  • Lung Diseases / microbiology*
  • Male
  • Mycobacterium avium Complex
  • Mycobacterium avium-intracellulare Infection / diagnosis*
  • Mycobacterium avium-intracellulare Infection / diagnostic imaging
  • Mycobacterium avium-intracellulare Infection / drug therapy
  • Mycobacterium avium-intracellulare Infection / mortality
  • Prognosis
  • Radiography
  • Retrospective Studies
  • Sex Factors

Substances

  • Anti-Bacterial Agents