Hyung-Jun Kim1, Nakwon Kwak2,3, Hyunsook Hong4, Noeul Kang5, Yunjoo Im5, Byung Woo Jhun5, Jae-Joon Yim2,6. 1. Armed Forces Capital Hospital, 90156, Division of Pulmonary and Critical Care Medicine, Department of Internal Medicine, Seongnam, Korea (the Republic of). 2. Seoul National University Hospital, 58927, Division of Pulmonary and Critical Care Medicine, Department of Internal Medicine, Seoul, Korea (the Republic of). 3. Seoul National University College of Medicine, 37990, Department of Internal Medicine, Seoul, Korea (the Republic of). 4. Seoul National University College of Medicine, 37990, Division of Medical Statistics, Medical Research Collaborating Center, Seoul, Korea (the Republic of). 5. Samsung Medical Center, 36626, Division of Pulmonary and Critical Care Medicine, Department of Medicine, Seoul, Korea (the Republic of). 6. Seoul National University College of Medicine, 37990, Department of Internal Medicine, Seoul, Korea (the Republic of); yimjj@snu.ac.kr.
Abstract
Rationale: Because the prognosis of nontuberculous mycobacterial pulmonary disease varies, a scoring system predicting mortality is needed. Objectives: We aimed to develop a novel scoring system to predict mortality among patients with nontuberculous mycobacterial pulmonary disease. Methods: We included patients age ≥20 years, newly diagnosed with nontuberculous mycobacterial pulmonary disease, with Mycobacterium avium, M. intracellulare, M. abscessus subsp. abscessus, or M. abscessus subsp. massiliense. Cox proportional hazards models were used to identify predictors of mortality in a derivation cohort, and a scoring system was developed. It was validated in an independent prospective cohort. Measurements and Main Results: A total 1,181 and 377 patients were included in the derivation and validation cohorts, respectively. In the final model, body mass index <18.5 kg/m2 (1 point), age ≥65 years (1 point), presence of cavity (1 point), elevated erythrocyte sedimentation rate (1 point), and male sex (1 point) were selected as predictors for mortality. We named this novel scoring system BACES (body mass index, age, cavity, erythrocyte sedimentation rate, and sex). Harrell's C-index for the BACES score was 0.812 (95% confidence interval: 0.786-0.837) in the derivation cohort and 0.854 (95% confidence interval: 0.797-0.911) in the validation cohort, indicating excellent discrimination performance. The estimated 5-year risk of mortality was 1.2% with BACES score 0 and 82.9% with BACES score 5. Conclusions: We developed the BACES score, which could accurately predict mortality among patients with nontuberculous mycobacterial pulmonary disease caused by M. avium, M. intracellulare, M. abscessus subsp. abscessus, or M. abscessus subsp. massiliense.
Rationale: Because the prognosis of nontuberculous mycobacterial pulmonary disease varies, a scoring system predicting mortality is needed. Objectives: We aimed to develop a novel scoring system to predict mortality among patients with nontuberculous mycobacterial pulmonary disease. Methods: We included patients age ≥20 years, newly diagnosed with nontuberculous mycobacterial pulmonary disease, with Mycobacterium avium, M. intracellulare, M. abscessus subsp. abscessus, or M. abscessus subsp. massiliense. Cox proportional hazards models were used to identify predictors of mortality in a derivation cohort, and a scoring system was developed. It was validated in an independent prospective cohort. Measurements and Main Results: A total 1,181 and 377 patients were included in the derivation and validation cohorts, respectively. In the final model, body mass index <18.5 kg/m2 (1 point), age ≥65 years (1 point), presence of cavity (1 point), elevated erythrocyte sedimentation rate (1 point), and male sex (1 point) were selected as predictors for mortality. We named this novel scoring system BACES (body mass index, age, cavity, erythrocyte sedimentation rate, and sex). Harrell's C-index for the BACES score was 0.812 (95% confidence interval: 0.786-0.837) in the derivation cohort and 0.854 (95% confidence interval: 0.797-0.911) in the validation cohort, indicating excellent discrimination performance. The estimated 5-year risk of mortality was 1.2% with BACES score 0 and 82.9% with BACES score 5. Conclusions: We developed the BACES score, which could accurately predict mortality among patients with nontuberculous mycobacterial pulmonary disease caused by M. avium, M. intracellulare, M. abscessus subsp. abscessus, or M. abscessus subsp. massiliense.
Entities:
Keywords:
Cohort studies; Mortality; Nontuberculous mycobacteria; Predictive value of tests
Authors: Hye-Rin Kang; Eui Jin Hwang; Sung A Kim; Sun Mi Choi; Jinwoo Lee; Chang-Hoon Lee; Jae-Joon Yim; Nakwon Kwak Journal: Open Forum Infect Dis Date: 2021-02-24 Impact factor: 3.835
Authors: Rebekah A Blakney; Emily E Ricotta; Dean Follmann; Jessica Drew; Kelly A Carey; Lisa N Glass; Chevalia Robinson; Sandra MacDonald; Pamela J McShane; Kenneth N Olivier; Kevin Fennelly; D Rebecca Prevots Journal: BMC Infect Dis Date: 2022-01-21 Impact factor: 3.090