Division of Pulmonology, Department of Internal Medicine, Far Eastern Memorial Hospital, New Taipei City, Taiwan; Department of Nursing, Oriental Institute of Technology, Taiwan.
Department of Chest Medicine, Taipei Veterans General Hospital, Taipei, Taiwan; School of Medicine, National Yang-Ming University, Taipei, Taiwan.
Respir Med. 2020 Sep;171:106070. doi: 10.1016/j.rmed.2020.106070. Epub 2020 Jun 25.
Mycobacterium avium complex-lung disease (MAC-LD) is increasing worldwide and may progress to cause mortality significantly. However, for patients without initial treatment at diagnosis, the survival outcomes and predictors of mortality remain unclear.
From 2011 to 2017, MAC-LD patients at two medical centers in Taiwan were screened, and those who received MAC treatment at the initial were excluded. The clinical course and characteristics were recorded. Cox regression analysis and receiver operating characteristic (ROC) curves were performed to assess risk factors of mortality within 4 years.
We included 123 MAC-LD patients without initial MAC treatment. The mean follow-up period was 4.15 ± 2.52 years. Twenty-two (17.9%) patients died within four years. Multivariate analysis showed that four independent factors related to 4-year mortality were consolidation pattern (hazard ratio [HR] 6.0, 95% confidence interval [2.3-15.5]), radiographic score > 6 (HR:11.0 [4.0-31.1]), radiographic deterioration within two years (HR: 5.2 [2.1-13.1]) and no MAC treatment during follow up (HR: 6.5 [1.3-31.1]). The areas under the ROC curves for prediction of 4-year mortality for the combination of consolidation and radiographic score >6, the two factors plus radiographic progression, the two plus no MAC treatment, and the combination of the four factors were 0.702, 0.798, 0.758, and 0.835, respectively.
The four-year mortality rate in MAC-LD without initial treatment is high. Presence of consolidation pattern and radiographic score >6 at initial visit, radiographic deterioration and no treatment during follow-up were risk factors of 4-year mortality in initially untreated MAC-LD.
鸟分枝杆菌复合群肺病（MAC-LD）在全球范围内呈上升趋势，可能显著导致死亡率增加。然而，对于那些在诊断时没有初始治疗的患者，其生存结果和死亡率预测因素尚不清楚。
2011 年至 2017 年，在台湾的两家医疗中心筛选了 MAC-LD 患者，并排除了那些在初始时接受 MAC 治疗的患者。记录了临床病程和特征。进行 Cox 回归分析和接收者操作特征（ROC）曲线分析，以评估 4 年内死亡的危险因素。
我们纳入了 123 例未接受初始 MAC 治疗的 MAC-LD 患者。平均随访时间为 4.15±2.52 年。22 例（17.9%）患者在 4 年内死亡。多因素分析显示，4 年内死亡的四个独立危险因素是实变模式（危险比[HR]6.0，95%置信区间[2.3-15.5]）、放射学评分>6（HR：11.0[4.0-31.1]）、两年内放射学恶化（HR：5.2[2.1-13.1]）和随访期间无 MAC 治疗（HR：6.5[1.3-31.1]）。预测 4 年死亡率的 ROC 曲线下面积，实变和放射学评分>6 的组合，两个因素加上放射学进展，两个加上没有 MAC 治疗，以及四个因素的组合分别为 0.702、0.798、0.758 和 0.835。
未经初始治疗的 MAC-LD 的 4 年死亡率较高。初诊时存在实变模式和放射学评分>6、放射学恶化和随访期间无治疗是未经初始治疗的 MAC-LD 患者 4 年死亡的危险因素。
