The factors associated with mortality and progressive disease of nontuberculous mycobacterial lung disease: a systematic review and meta-analysis

Abstract

This systematic review and meta-analysis aimed to comprehensively evaluate the factors associated with mortality and progressive disease in NTM-LD patients. We conducted a literature search to identify the eligible studies, dated between January 1, 2007, and April 12, 2021. Forty-one studies with total 10,452 patients were included. The overall all-cause mortality rate was 20% (95% CI 17–24%). The overall rates of clinical and radiographic progressive disease were 46% (95% CI 39–53%) and 43% (95% CI 31–55%), respectively. Older age, male sex, history of TB, diabetes, chronic heart disease, malignancy, systemic immunosuppression, chronic liver disease, presence of cavity, consolidative radiologic features, acid-fast bacillus (AFB) smear positivity, hypoalbuminemia, anemia, increasing platelet count, high CRP, and high ESR were significantly associated with increased all-cause mortality, whereas increasing body mass index (BMI), hemoptysis, and treatment with rifamycin regimen (in M. xenopi) were significantly associated with decreased all-cause mortality in multivariable analysis. History of TB, Aspergillus co-infection, cough, increased sputum, weight loss, presence of cavity, and AFB smear positivity were significantly associated with increased clinical progression with treatment, while older age and low BMI were significantly associated with decreased clinical progression in multivariable analysis. Older age, interstitial lung disease, presence of cavity, consolidative radiologic feature, anemia, high CRP, and leukocytosis were significantly associated with increased radiographic progression after adjusting for covariates. Older age, history of tuberculosis, presence of cavity, consolidative radiologic features, AFB smear positivity, anemia, and high C-reactive protein were common significant factors associated with the all-cause mortality and clinical or radiographic progressive disease of NTM-LD. These factors are thought to directly affect NTM-LD related mortality. The future prediction models for the prognosis of NTM-LD should be established considering these factors.

Multiparameter immunoprofiling for the diagnosis and differentiation of progressive versus nonprogressive nontuberculous mycobacterial lung disease–A pilot study

“…Despite recent progress made in developing risk scores to predict mortality associated with NTM-PD, little progress has been made to predict individual disease progression in patients without cavitary and/or severe disease. The BACES score is composed of low BMI (<18.5 kg/ m 2 ), advanced age (�65 years), presence of cavity, elevated ESR, and male sex which can predict mortality in patients with NTM pulmonary disease [16,21]. However, most of these were not significantly associated with progressive disease in our study, and may not directly affect the NTM-LD progression.…”

“…Recently, a study reported that high serum levels of Krebs von den Lungen-6 (KL-6) was associated with disease progression in MAC lung disease [24]. Further, systemic inflammatory markers, history of TB, cough, weight loss, presence of cavity and malnutrition were also reported as predictive for disease deterioration in NTM-LD [21,22,25,26]. However, the results are highly heterologous and depend on the study patients' characteristics, the study settings, and lack of controlled clinical trials renders them inconclusive.…”

Epidemiological Characteristics of Nontuberculous Mycobacterial Pulmonary Disease in South Korea: A Meta-analysis of Individual Participant Data

“…Individuals aged 65 and older showed a higher proportion of men, and a higher proportion of patients with BMI <18.5 kg/m 2 ( Table 3 ), indicative of a poorer NTM-PD prognosis. Given the anticipated worse outcomes in the older demographic [ 36 ], proactive treatment consideration is critical. Notably, treatment-related adverse events are commonly reported among NTM-PD patients [ 37 ], and those over 65 in our study also exhibited a higher prevalence of underlying respiratory (COPD, asthma, and interstitial lung disease) and non-respiratory (hypertension, diabetes, chronic kidney diseases, and chronic heart disease) conditions, necessitating vigilant monitoring for drug-related adverse events during treatment.…”

Drugs for treating infections caused by non-tubercular mycobacteria: a narrative review from the study group on mycobacteria of the Italian Society of Infectious Diseases and Tropical Medicine

“…Among patients affected by NTM-PD, weight loss and low BMI have been associated with disease progression, unfavorable outcomes, and increased mortality rates, even among those receiving treatment [ 31 ]. Although studies exploring the benefits of nutritional supplementation in patients with NTM-PD remain scarce, it is widely acknowledged that nutrition support and weight gain play a crucial role to help patients fight infection.…”