Impact of Aspergillus precipitating antibody test results on clinical outcomes of patients with Mycobacterium avium complex lung disease. (May 2020)

• Record Type: Journal Article
• Authors: Shirai, Tatsuya; Furuuchi, Koji; Fujiwara, Keiji; Nakamoto, Keitaro; Tanaka, Yoshiaki; Ishii, Haruyuki; Yoshiyama, Takashi; Yoshimori, Kozo; Takizawa, Hajime; Sasaki, Yuka; Kurashima, Atsuyuki; Ohta, Ken; Morimoto, Kozo
• Is Part Of: Respiratory medicine. Volume 166(2020)
• Publication Date: 2020-05
• Subjects: Aspergillus precipitating antibody -- Clinical outcomes -- Mycobacterium avium complex -- Prognosis -- Pulmonary aspergillosis; Chest -- Diseases -- Periodicals; Chest -- Diseases -- Great Britain -- Periodicals; Respiratory organs -- Diseases -- Periodicals; Respiratory Tract Diseases -- Periodicals; Appareil respiratoire -- Maladies -- Périodiques; Thorax -- Maladies -- Périodiques; Appareil respiratoire -- Maladies -- Traitement -- Périodiques; Electronic journals; 616.2
• DOI: 10.1016/j.rmed.2020.105955
• Languages: English
• ISSNs: 0954-6111

Abstract

Abstract: Background and objective: Chronic pulmonary aspergillosis (CPA) is associated with mortality in patients with Mycobacterium avium complex lung disease (MAC-LD). However, the clinical significance of the positivity of Aspergillus precipitating antibody (APAb), a serodiagnostic test for pulmonary aspergillosis (PA), at the time of MAC-LD diagnosis is unknown. The objective of this study was to investigate the effects of APAb test results on the clinical outcomes of patients with MAC-LD. Methods: We retrospectively analyzed patients who were newly diagnosed as having MAC-LD between 2007 and 2014 in our hospital and checked for APAb at the time of diagnosis. Results: We enrolled 131 patients in this study. Of these patients, 20 (15.3%) tested positive for APAb at the diagnosis of MAC-LD. The APAb-positive patients were more frequently male (70.0% vs. 37.8%, P = 0.013) and more frequently had pulmonary emphysema (60.0% vs. 13.5%, P < 0.001) and interstitial pneumonia (15.0% vs. 1.8%, P = 0.025) compared with the APAb-negative patients. During a median follow-up period of 4.0 years, PA developed in 12 of the APAb-positive patients (60.0%, CPA: 9 and allergic bronchopulmonary aspergillosis: 3) and 12 APAb-negative patients (10.8%, CPA: 12) ( P < 0.001). The APAb-positive patients had a significantly higher rate of mortality than did the APAb-negative patients ( P = 0.004). A multivariate analysis indicated that older age, lower albumin, fibrocavitary or fibrocavitary and nodular/bronchiectatic radiographic features, and APAb positivity were negative prognostic factors. Conclusions: APAb-positive patients with MAC-LD more frequently develop PA and may have an unfavorable prognosis. Highlights: APAb-positive patients with MAC-LD more frequently had underlying lung disease. APAb-positive patients with MAC-LD more frequently develop PA. APAb positivity was an independent negative prognostic factor in MAC-LD patients.