title: Retrospective study of the predictors of mortality and radiographic deterioration in 782 patients with nodular/bronchiectatic Mycobacterium avium complex lung disease.
abstract: OBJECTIVE
  Some patients with nodular/bronchiectatic Mycobacterium avium complex lung disease (NB MAC-LD) deteriorate and die. The main aim of the study is to evaluate the prognostic factors and radiographic outcomes in patients with NB MAC-LD.
  
  
  METHODS
  Retrospective single-centre review.
  
  
  METHODS
  782 HIV-negative patients with NB MAC-LD treated at our institution in Japan.
  
  
  METHODS
  All-cause and MAC-LD progression mortality rates and the prognostic factors, and radiographic deterioration rates and the prognostic factors.
  
  
  RESULTS
  Mean age was 68.1 years, and median follow-up period was 4.3 years. Death from any cause and progression of MAC lung disease (MAC-LD) occurred in 130 (16.6%), and 19 (2.4%) patients, respectively. All-cause and MAC-LD progression 10-year mortality rates were 27.4% and 4.8%, respectively. In 536 patients with MAC-LD who were followed-up for more than 1 year, radiographic deterioration occurred in 221 (41.2%) patients and median time-to-radiographic deterioration was 9 years. A multivariate Cox proportional hazard model showed male sex, older age, body mass index <18.5 kg/m(2), absence of bloody sputum, hypoalbuminaemia and erythrocyte sedimentation rate >40 mm/h to be negative prognostic factors for all-cause mortality, and the presence of idiopathic pulmonary fibrosis, haemoglobin <11.3 mg/dL, C reactive protein >1.0 mg/dL and the presence of cavity to be negative prognostic factors for radiographic deterioration.
  
  
  CONCLUSIONS
  Only 2.4% of patients with NB MAC-LD died from MAC-LD progression. As clinical trials testing the effectiveness of drug therapy in patients with NB MAC-LD are being designed and implemented, the primary end point could be time-to-radiographic deterioration, and trial patients need to be stratified according to these prognostic factors before randomisation.
authors.affiliation: Department of Respiratory Medicine, Saitama Cardiovascular and Respiratory Center, Kumagaya, Saitama, Japan.
authors.forename: Mina
authors.initials: M
authors.lastname: Gochi
authors.affiliation: Department of Respiratory Medicine, Saitama Cardiovascular and Respiratory Center, Kumagaya, Saitama, Japan.
authors.forename: Noboru
authors.initials: N
authors.lastname: Takayanagi
authors.affiliation: Department of Radiology, Saitama Cardiovascular and Respiratory Center, Kumagaya, Saitama, Japan.
authors.forename: Tetsu
authors.initials: T
authors.lastname: Kanauchi
authors.affiliation: Department of Respiratory Medicine, Saitama Cardiovascular and Respiratory Center, Kumagaya, Saitama, Japan.
authors.forename: Takashi
authors.initials: T
authors.lastname: Ishiguro
authors.affiliation: Department of Respiratory Medicine, Saitama Cardiovascular and Respiratory Center, Kumagaya, Saitama, Japan.
authors.forename: Tsutomu
authors.initials: T
authors.lastname: Yanagisawa
authors.affiliation: Department of Respiratory Medicine, Saitama Cardiovascular and Respiratory Center, Kumagaya, Saitama, Japan.
authors.forename: Yutaka
authors.initials: Y
authors.lastname: Sugita
mesh_terms: D000368:Aged; D000900:Anti-Bacterial Agents / Q000145:classification / Q000627:therapeutic use*; D001987:Bronchiectasis / Q000150:complications* / Q000382:microbiology; D002423:Cause of Death; D018450:Disease Progression; D005260:Female; D018023:HIV Seronegativity; D006801:Humans; D007564:Japan / Q000453:epidemiology; D053208:Kaplan-Meier Estimate; D008168:Lung / Q000382:microbiology*; D008171:Lung Diseases / Q000382:microbiology / Q000401:mortality*; D008297:Male; D008875:Middle Aged; D015999:Multivariate Analysis; D015269:Mycobacterium avium Complex / Q000235:genetics; D015270:Mycobacterium avium-intracellulare Infection / Q000401:mortality*; D011379:Prognosis; D016016:Proportional Hazards Models; D012189:Retrospective Studies; D012307:Risk Factors; D013183:Sputum / Q000382:microbiology
chemical_list: D000900:Anti-Bacterial Agents