Clinical Characteristics and Risk Factors for Chronic Pulmonary Aspergillosis in Patients with Nontuberculous Mycobacterial Pulmonary Disease

TL;DR

This study identifies risk factors for chronic pulmonary aspergillosis in patients with nontuberculous mycobacterial lung disease and highlights the importance of early detection.

Contribution

The study provides new insights into risk factors and clinical outcomes of CPA in NTM-PD patients in mainland China.

Findings

26.6% of NTM-PD patients had concurrent CPA.

Male sex, dyspnea, and cavity were significant risk factors for CPA.

Unadjusted mortality was higher in NTM-PD patients with CPA.

Abstract

Background: The incidence of patients with nontuberculous mycobacterial pulmonary disease (NTM-PD) complicated by chronic pulmonary aspergillosis (CPA) has been increasing. CPA is known to be associated with complex treatment regimens and a poor prognosis. However, data from mainland China remain scarce. This single-center retrospective study aimed to evaluate the clinical characteristics, risk factors, and prognoses of patients with concurrent CPA and NTM-PD. Methods: We conducted a retrospective review of the medical records of 248 patients diagnosed with NTM-PD. Risk factors for CPA were analyzed via multiple logistic regression, followed by survival analysis. Results: Among the 248 patients with NTM-PD, 66 (26.6%) were diagnosed with CPA. Independent risk factors for NTM-PD and CPA coinfection included male sex (OR 2.13, 95% CI: 1.03–4.47), dyspnea (OR 27.9, 95% CI: 4.24–570), cavity (OR 5.95, 95% CI: 2.76–13.9), use of oral corticosteroids (OR 4.28, 95% CI: 1.13–16.6), and interstitial lung disease (OR 15.5, 95% CI: 1.89–361). The wide confidence intervals for some risk factors reflect limited precision. The Kaplan–Meier survival curves indicated a significant divergence between the NTM-PD group and the NTM-PD with CPA group (log-rank test, p = 0.00039). However, the adjusted hazard ratio was not statistically significant (HR 2.01, 95% CI: 0.66–6.12, p = 0.217). Conclusions: In patients with NTM-PD, the presence of concurrent CPA was associated with higher unadjusted mortality. Clinicians should maintain a high index of suspicion for CPA to ensure prompt diagnosis and treatment, particularly in high-risk individuals.

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