# 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.

## Key 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.