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Risk stratification for the development of chronic pulmonary aspergillosis in patients with Mycobacterium avium

Koji Furuuchi1, Akihiro Ito1, Toru Hashimoto1

  • 1Department of Respiratory Medicine, Ohara Healthcare Foundation, Kurashiki Central Hospital, Kurashiki, Japan.

Journal of Infection and Chemotherapy : Official Journal of the Japan Society of Chemotherapy
|April 30, 2018
PubMed
Abstract

Insights

This study identified key risk factors for developing chronic pulmonary aspergillosis (CPA) in patients with Mycobacterium avium complex lung disease (MAC-LD). A simple scoring system helps stratify patients into low- and high-risk groups for CPA development.

Area of Science:

  • Pulmonology
  • Infectious Diseases
  • Medical Mycology

Background:

  • Increasing incidence of pulmonary nontuberculous mycobacterial disease (NTM) complicated by chronic pulmonary aspergillosis (CPA).
  • Association between CPA and mortality in Mycobacterium avium complex lung disease (MAC-LD) patients.

Purpose of the Study:

  • Identify risk factors for CPA development in MAC-LD patients.
  • Develop a risk stratification system for CPA in MAC-LD.

Main Methods:

  • Retrospective analysis of 361 newly diagnosed MAC-LD patients.
  • Multivariate Cox proportional hazards regression for risk factor identification.
  • Receiver operating characteristic (ROC) curve analysis for risk stratification.

Main Results:

  • CPA developed in 5.5% of patients.
  • Independent risk factors: pulmonary emphysema, baseline steroid use, low serum albumin (<3.5 g/dL), MAC-LD cavities.
  • A 4-point scoring system created low-risk (0-1 point) and high-risk (2-4 points) groups.
  • 5-year CPA incidence: 2.2% (low-risk) vs. 31% (high-risk).

Conclusions:

  • Identified independent predictors for CPA development in MAC-LD.
  • Established a practical risk stratification system to identify high-risk patients.
Keywords:
Chronic pulmonary aspergillosisMycobacterium avium complex lung diseaseRisk factors

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