Department of Internal Medicine, University of Ulsan College of Medicine, Asan Medical Center, Seoul, South Korea.
Department of Clinical Epidemiology and Biostatistics, University of Ulsan College of Medicine, Asan Medical Center, Seoul, South Korea.
Chest. 2024 Sep;166(3):442-451. doi: 10.1016/j.chest.2024.03.027. Epub 2024 Mar 18.
The association between treatment outcome and the mortality of patients with Mycobacterium avium complex pulmonary disease (MAC-PD) with cavitary lesions is unclear. This article assessed the impact of culture conversion on mortality in patients with cavitary MAC-PD.
Is the achievement of sputum culture conversion in patients with MAC-PD with cavitary lesions associated with the prognosis?
From 2002 to 2020, a total of 351 patients with cavitary MAC-PD (105 with the fibrocavitary type and 246 with the cavitary nodular bronchiectatic type), who had been treated with a ≥ 6-month macrolide-containing regimen at a tertiary referral center in South Korea, were retrospectively enrolled in this study. All-cause mortality during the follow-up period was analyzed based on culture conversion at the time of treatment completion.
The cohort had a median treatment duration of 14.7 months (interquartile range [IQR], 13.4-16.8 months). Of the 351 patients, 69.8% (245 of 351) achieved culture conversion, and 30.2% (106 of 351) did not. The median follow-up was 4.4 years (IQR, 2.3-8.3 years) in patients with culture conversion and 3.1 years (IQR, 2.1-4.8 years) in those without. For the patients with and without culture conversion, all-cause mortality was 5.3% vs 35.8% (P < .001), and the 5-year cumulative mortality was 20.0% vs 38.4%, respectively. Cox analysis found that a lack of culture conversion was significantly associated with higher mortality (adjusted hazard ratio, 5.73; 95% CI, 2.86-11.50). Moreover, the 2-year landmark analysis revealed a distinct impact of treatment outcome on mortality.
The mortality rate of patients with cavitary MAC-PD who did not achieve culture conversion was significantly higher than that of those with culture conversion.
分枝杆菌复合群肺病（MAC-PD）有空洞病变患者的治疗结果与死亡率之间的关联尚不清楚。本文评估了空洞 MAC-PD 患者痰培养转换对死亡率的影响。
MAC-PD 有空洞病变的患者痰培养转归是否与预后相关？
本研究回顾性纳入了 2002 年至 2020 年期间在韩国一家三级转诊中心接受至少 6 个月大环内酯类药物治疗的 351 例空洞 MAC-PD 患者（105 例纤维空洞型，246 例空洞结节性支气管扩张型）。根据治疗完成时的培养转换情况，分析随访期间的全因死亡率。
该队列的中位治疗时间为 14.7 个月（四分位距 [IQR]，13.4-16.8 个月）。351 例患者中，69.8%（245/351）痰培养转换，30.2%（106/351）未转换。培养转换患者的中位随访时间为 4.4 年（IQR，2.3-8.3 年），未转换患者为 3.1 年（IQR，2.1-4.8 年）。对于培养转换和未转换的患者，全因死亡率分别为 5.3%和 35.8%（P<0.001），5 年累积死亡率分别为 20.0%和 38.4%。Cox 分析发现，未培养转换与死亡率显著升高相关（调整后的危险比，5.73；95%CI，2.86-11.50）。此外，2 年的时间截点分析显示，治疗结果对死亡率有明显影响。
未培养转换的空洞 MAC-PD 患者的死亡率明显高于培养转换的患者。
