Clinical Features and Prognosis of Nontuberculous Mycobacterial Pleuritis: A Multicenter Retrospective Study
Kazuma Yagi, Akihiro Ito, Keiji Fujiwara, Eriko Morino, Isano Hase, Yasushi Nakano, Takanori Asakura, Koji Furuuchi, Atsuho Morita, Takahiro Asami, Ho Namkoong, Fumitake Saito, Kozo Morimoto, Makoto Ishii, Yasunori Sato, Hiroki Tateno, Kazumi Nishio, Yoshitaka Oyamada, Koichi Fukunaga, Haruhito Sugiyama, Tadashi Ishida, Atsuyuki Kurashima, Naoki Hasegawa
Abstract
Abstract Rationale The clinical features and prognosis of nontuberculous mycobacterial (NTM) pleuritis and pleural effusion combined with NTM lung disease 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 NTM culture of pleural effusion samples. We matched patients with Mycobacterium avium complex (MAC) lung disease (MAC-LD) without pleuritis by sex and age to obtain comparative data and investigated the association between clinical parameters and the prognosis. Results We identified 64 patients with NTM pleuritis (median age, 73 yr; 37 female patients). The median follow-up duration was 11 months, and 27 patients died. Patients with MAC pleuritis had a significantly lower survival rate than matched patients with MAC-LD without pleuritis. Multivariate analysis revealed that pleuritis (adjusted hazard ratio, 6.99; 95% confidence interval [CI], 2.58–19.00) and underlying pulmonary diseases (adjusted hazard ratio, 3.01; 95% CI, 1.44–6.28) were independently associated with all-cause mortality in patients with MAC-LD. 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.