Prognostic factors associated with long-term mortality in 1445 patients with nontuberculous mycobacterial pulmonary disease: A 15-year follow-up study

Byung Woo Jhun; Seong Mi Moon; Kyeongman Jeon; O. Jung Kwon; Heejin Yoo; Keumhee C. Carriere; Hee Jae Huh; Nam Yong Lee; Sung Jae Shin; Charles L. Daley; Won Jung Koh

doi:10.1183/13993003.00798-2019

Prognostic factors associated with long-term mortality in 1445 patients with nontuberculous mycobacterial pulmonary disease: A 15-year follow-up study

Byung Woo Jhun, Seong Mi Moon, Kyeongman Jeon, O. Jung Kwon, Heejin Yoo, Keumhee C. Carriere, Hee Jae Huh, Nam Yong Lee, Sung Jae Shin, Charles L. Daley, Won Jung Koh

Department of Microbiology

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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.

Original language	English
Article number	1900798
Journal	European Respiratory Journal
Volume	55
Issue number	1
DOIs	https://doi.org/10.1183/13993003.00798-2019
Publication status	Published - 2020 Jan 1

Bibliographical note

Funding Information:
Support statement: This work was supported by the National Research Foundation of Korea (NRF) funded by the Korea government (MSIT) (NRF-2018R1A2A1A05018309). The sponsor had no role in the design of the study, the collection and analysis of the data, or the preparation of the manuscript. Funding information for this article has been deposited with the Crossref Funder Registry.

Publisher Copyright:
Copyright © ERS 2020

All Science Journal Classification (ASJC) codes

Pulmonary and Respiratory Medicine

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10.1183/13993003.00798-2019

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Jhun, B. W., Moon, S. M., Jeon, K., Jung Kwon, O., Yoo, H., Carriere, K. C., Huh, H. J., Lee, N. Y., Shin, S. J., Daley, C. L., & Koh, W. J. (2020). Prognostic factors associated with long-term mortality in 1445 patients with nontuberculous mycobacterial pulmonary disease: A 15-year follow-up study. European Respiratory Journal, 55(1), [1900798]. https://doi.org/10.1183/13993003.00798-2019

@article{0027657d7a7f454b89588e3e71790565,

title = "Prognostic factors associated with long-term mortality in 1445 patients with nontuberculous mycobacterial pulmonary disease: A 15-year follow-up study",

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-na{\"i}ve 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.",

author = "Jhun, {Byung Woo} and Moon, {Seong Mi} and Kyeongman Jeon and {Jung Kwon}, O. and Heejin Yoo and Carriere, {Keumhee C.} and Huh, {Hee Jae} and Lee, {Nam Yong} and Shin, {Sung Jae} and Daley, {Charles L.} and Koh, {Won Jung}",

note = "Funding Information: Support statement: This work was supported by the National Research Foundation of Korea (NRF) funded by the Korea government (MSIT) (NRF-2018R1A2A1A05018309). The sponsor had no role in the design of the study, the collection and analysis of the data, or the preparation of the manuscript. Funding information for this article has been deposited with the Crossref Funder Registry. Publisher Copyright: Copyright {\textcopyright} ERS 2020",

year = "2020",

month = jan,

day = "1",

doi = "10.1183/13993003.00798-2019",

language = "English",

volume = "55",

journal = "Scandinavian Journal of Respiratory Diseases",

issn = "0903-1936",

publisher = "European Respiratory Society",

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Jhun, BW, Moon, SM, Jeon, K, Jung Kwon, O, Yoo, H, Carriere, KC, Huh, HJ, Lee, NY, Shin, SJ, Daley, CL & Koh, WJ 2020, 'Prognostic factors associated with long-term mortality in 1445 patients with nontuberculous mycobacterial pulmonary disease: A 15-year follow-up study', European Respiratory Journal, vol. 55, no. 1, 1900798. https://doi.org/10.1183/13993003.00798-2019

TY - JOUR

T1 - Prognostic factors associated with long-term mortality in 1445 patients with nontuberculous mycobacterial pulmonary disease

T2 - A 15-year follow-up study

AU - Jhun, Byung Woo

AU - Moon, Seong Mi

AU - Jeon, Kyeongman

AU - Jung Kwon, O.

AU - Yoo, Heejin

AU - Carriere, Keumhee C.

AU - Huh, Hee Jae

AU - Lee, Nam Yong

AU - Shin, Sung Jae

AU - Daley, Charles L.

AU - Koh, Won Jung

N1 - Funding Information: Support statement: This work was supported by the National Research Foundation of Korea (NRF) funded by the Korea government (MSIT) (NRF-2018R1A2A1A05018309). The sponsor had no role in the design of the study, the collection and analysis of the data, or the preparation of the manuscript. Funding information for this article has been deposited with the Crossref Funder Registry. Publisher Copyright: Copyright © ERS 2020

PY - 2020/1/1

Y1 - 2020/1/1

N2 - 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.

AB - 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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Prognostic factors associated with long-term mortality in 1445 patients with nontuberculous mycobacterial pulmonary disease: A 15-year follow-up study

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