Kazuma Yagi1,2, Akihiro Ito3, Keiji Fujiwara4, Eriko Morino5, Isano Hase6, Yasushi Nakano7, Takanori Asakura8, Koji Furuuchi4, Atsuho Morita1, Takahiro Asami1,6, Ho Namkoong8,9, Fumitake Saito10, Kozo Morimoto4, Makoto Ishii8, Yasunori Sato11, Hiroki Tateno6, Kazumi Nishio7, Yoshitaka Oyamada2, Koichi Fukunaga8, Haruhito Sugiyama5, Tadashi Ishida3, Atsuyuki Kurashima4, Naoki Hasegawa12. 1. Keio University School of Medicine, Division of Pulmonary Medicine, Department of Medicine, Shunjuku-ku, Tokyo, Japan. 2. National Hospital Organisation Tokyo Medical Center, 38547, Department of Respiratory Medicine, Meguro-ku, Tokyo, Japan. 3. Ohara Healthcare Foundation, Kurashiki Central Hospital, Department of Respiratory Medicine, Kurashiki, Okayama, Japan. 4. Fukujuji Hospital, Japan Anti-Tuberculosis Association, Respiratory Disease Center, Kiyose, Tokyo, Japan. 5. National Center for Global Health and Medicine Hospital, 200682, Department of Respiratory Medicine, Shinjuku-ku, Tokyo, Japan. 6. Saitama City Hospital, 435114, Department of Pulmonary Medicine, Saitama, Saitama, Japan. 7. Kawasaki City Ida Hospital, Department of Respiratory Medicine, Kawasaki, Kanagawa, Japan. 8. Keio University School of Medicine, Division of Pulmonary Medicine, Department of Medicine, Shinjuku-ku, Tokyo, Japan. 9. Eiju General Hospital, Department of Pulmonary Medicine, Taito-ku, Tokyo, Japan. 10. Eiju General Hospital, Department of Pulmonary Medicine, Taito, Tokyo, Japan. 11. Keio University School of Medicine, Department of Preventive Medicine and Public Health, Shinjuku-ku, Tokyo, Japan. 12. Keio University School of Medicine, Department of Infectious Diseases, Shinjuku-ku, Tokyo, Japan; n-hasegawa@z8.keio.jp.
Abstract
RATIONALE: The clinical features and prognosis of nontuberculous mycobacterial (NTM) pleuritis and pleural effusion combined with NTM lung disease (NTM-LD) remain unclear. OBJECTIVES: To investigate the clinical features and prognosis of NTM pleuritis. METHODS: This retrospective observational study included patients with NTM pleuritis from January 2001 to June 2018 across eight hospitals in Japan. NTM pleuritis was defined by a positive culture of NTM from pleural effusion. We matched patients with Mycobacterium complex lung disease (MAC-LD) without pleuritis by sex and age to obtain comparative data and investigated the association between clinical parameters and prognosis. RESULTS: We identified 64 patients with NTM pleuritis (median age, 73 years; 37 female). The median follow-up duration was 11 months, and 27 patients died. Patients with MAC pleuritis had a significantly worse survival compared to matched patients with MAC-LD without pleuritis. Multivariate analysis revealed that pleuritis (adjusted hazard ratio [aHR], 6.99; 95% confidence interval [CI], 2.58-19.00) and underlying pulmonary diseases (aHR, 3.01; 95% CI, 1.44-6.28) were independently associated with all-cause mortality in MAC-LD patients. CONCLUSIONS: The prognosis of MAC pleuritis is poorer than that of MAC-LD without pleuritis. Pleuritis is an independent prognostic factor in patients with MAC-LD.
RATIONALE: The clinical features and prognosis of nontuberculous mycobacterial (NTM) pleuritis and pleural effusion combined with NTM lung disease (NTM-LD) remain unclear. OBJECTIVES: To investigate the clinical features and prognosis of NTM pleuritis. METHODS: This retrospective observational study included patients with NTM pleuritis from January 2001 to June 2018 across eight hospitals in Japan. NTM pleuritis was defined by a positive culture of NTM from pleural effusion. We matched patients with Mycobacterium complexlung disease (MAC-LD) without pleuritis by sex and age to obtain comparative data and investigated the association between clinical parameters and prognosis. RESULTS: We identified 64 patients with NTM pleuritis (median age, 73 years; 37 female). The median follow-up duration was 11 months, and 27 patientsdied. Patients with MAC pleuritis had a significantly worse survival compared to matched patients with MAC-LD without pleuritis. Multivariate analysis revealed that pleuritis (adjusted hazard ratio [aHR], 6.99; 95% confidence interval [CI], 2.58-19.00) and underlying pulmonary diseases (aHR, 3.01; 95% CI, 1.44-6.28) were independently associated with all-cause mortality in MAC-LD patients. CONCLUSIONS: The prognosis of MAC pleuritis is poorer than that of MAC-LD without pleuritis. Pleuritis is an independent prognostic factor in patients with MAC-LD.