한빛사 논문
Byung Woo Jhun1,11⇑, Seong Mi Moon2,11, Kyeongman Jeon1, O Jung Kwon1, Heejin Yoo3, Keumhee C. Carriere3,4, Hee Jae Huh5, Nam Yong Lee5, Sung Jae Shin6,7,8, Charles L. Daley9,10 and Won-Jung Koh1
1 Division of Pulmonary and Critical Care Medicine, Dept of Medicine, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, South Korea
2 Division of Pulmonary and Critical Care Medicine, Dept of Medicine, Samsung Changwon Hospital, Sungkyunkwan University School of Medicine, Changwon, South Korea
3 Statistics and Data Center, Samsung Medical Center, Seoul, South Korea
4 Dept of Mathematical and Statistical Sciences, University of Alberta, Edmonton, AB, Canada
5 Dept of Laboratory Medicine and Genetics, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, South Korea
6 Dept of Microbiology, Yonsei University College of Medicine, Seoul, South Korea
7 Institute for Immunology and Immunological Disease, Yonsei University College of Medicine, Seoul, South Korea
8 Brain Korea 21 PLUS Project for Medical Science, Yonsei University College of Medicine, Seoul, South Korea
9 Division of Mycobacterial and Respiratory Infections, Dept of Medicine, National Jewish Health, Denver, CO, USA
10 Dept of Medicine, University of Colorado, Aurora, CO, USA
11 Both authors contributed equally
⇑Correspondence : Byung Woo Jhun, Samsung Medical Center, Division of Pulmonary and Critical Care Medicine, Irwon-ro 81, Gangnam-gu, Seoul, 06351, South Korea
Abstract
Limited data are available regarding the prognostic factors for patients with nontuberculous mycobacterial pulmonary disease (NTM-PD). We investigated the prognostic factors associated with long-term mortality in NTM-PD patients after adjusting for individual confounders, including aetiological organism and radiological form.
A total of 1445 patients with treatment-naïve NTM-PD who were newly diagnosed between July 1997 and December 2013 were included. The aetiological organisms were as follows: Mycobacterium avium (n=655), M. intracellulare (n=487), M. abscessus (n=129) and M. massiliense (n=174). The factors associated with mortality in NTM-PD patients were analysed using a multivariable Cox model after adjusting for demographic, radiological and aetiological data.
The overall 5-, 10- and 15-year cumulative mortality rates for the NTM-PD patients were 12.4%, 24.0% and 36.4%, respectively. On multivariable analysis, the following factors were significantly associated with mortality in NTM-PD patients: old age, male sex, low body mass index, chronic pulmonary aspergillosis, pulmonary or extrapulmonary malignancy, chronic heart or liver disease and erythrocyte sedimentation rate. The aetiological organism was also significantly associated with mortality: M. intracellulare had an adjusted hazard ratio (aHR) of 1.40, 95% CI 1.03–1.91; M. abscessus had an aHR of 2.19, 95% CI 1.36–3.51; and M. massiliense had an aHR of 0.99, 95% CI 0.61–1.64, compared to M. avium. Mortality was also significantly associated with the radiological form of NTM-PD for the cavitary nodular bronchiectatic form (aHR 1.70, 95% CI 1.12–2.59) and the fibrocavitary form (aHR 2.12, 95% CI 1.57–3.08), compared to the non-cavitary nodular bronchiectatic form.
Long-term mortality in patients with NTM-PD was significantly associated with the aetiological NTM organism, cavitary disease and certain demographic characteristics.
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