Risk Factors and Prognostic Effects of Aspergillosis as a Complication of Nontuberculous Mycobacterial Pulmonary Disease: A Nested Case–Control Study
Funding: The authors received no specific funding for this work.
Takahiro Takazono and Shotaro Ide are co-first authors.
The abstract of this manuscript was presented at the 99th Congress of the Japanese Society of Tuberculosis and Non-Tuberculous Mycobacteriosis on May 31, 2024.
ABSTRACT
Objective
The global prevalence of nontuberculous mycobacterial pulmonary disease (NTM-PD) has been steadily increasing. A few small retrospective studies have reported a poor prognosis associated with chronic pulmonary aspergillosis (CPA) as a complication of NTM-PD. Furthermore, the prognostic impact of CPA may have been inadequately assessed due to differences in background factors. This study aimed to identify the risk factors for CPA in NTM-PD and compare the risk of in-hospital mortality between patients with and without aspergillosis.
Methods
Data were obtained from a large-scale claims database. Patients with NTM-PD who met the inclusion criteria and those who developed CPA after the NTM diagnosis were identified. The incidence of CPA was evaluated, and risk factors were identified using multiple logistic analyses. Mortality rates were evaluated and compared between patients with and without aspergillosis after adjusting for background CPA risk factors.
Results
The incidence of CPA was 2.29% (265/11,587). The identified risk factors included male sex, chronic respiratory failure, asthma, interstitial pneumonia, pulmonary tuberculosis sequelae and systemic corticosteroid use. A total of 219 patients with CPA were matched with control cases using propensity scores based on age and identified risk factors for CPA. The adjusted hazard ratio for in-hospital mortality was 2.6 (95% CI: 1.8–3.9).
Conclusions
CPA as a complication of NTM-PD is associated with significantly higher mortality rates. Clinicians should consider the necessity of promptly diagnosing CPA in patients with NTM-PD and the associated risk factors.
Conflicts of Interest
The authors declare no conflicts of interest.
Open Research
Data Availability Statement
The data that support the findings of this study are available from Medical data vision. Restrictions apply to the availability of these data, which were used under license for this study. Data are available from the author(s) with the permission of Medical data vision.
