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Observational Study
. 2017 Jun 19;17(1):436.
doi: 10.1186/s12879-017-2544-0.

Development and validation of a prognostic scoring model for Mycobacterium avium complex lung disease: an observational cohort study

Shogo Kumagai  1 , Akihiro Ito  2 , Toru Hashimoto  2 , Satoshi Marumo  3 , Hironobu Tokumasu  4 , Aya Kotani  3 , Haruka Yamaki  3 , Masahiro Shirata  3 , Koji Furuuchi  2 , Motonari Fukui  3 , Tadashi Ishida  2
Affiliations
Observational Study

Development and validation of a prognostic scoring model for Mycobacterium avium complex lung disease: an observational cohort study

Shogo Kumagai et al. BMC Infect Dis. .

Abstract

Background: Patients with Mycobacterium avium complex (MAC) lung disease (LD) have a heterogeneous prognosis. This study aimed to develop and validate a prognostic scoring model for these patients using independent risk factors for survival.

Methods: We retrospectively analyzed the data of patients with MAC-LD from two hospitals (cohort 1, n = 368; cohort 2, n = 118). Cohort 1 was evaluated using a multivariate Cox proportional hazards model to identify independent risk factors for overall survival (OS). A prognostic scoring model composed of these factors was developed, and cohort 1 was stratified into three groups according to risk using the log-rank test. Finally, the prognostic scoring model was validated using the data of cohort 2.

Results: Seven independent risk factors for OS were selected from cohort 1, including the male sex, age ≥ 70 years, the presence of a malignancy, body mass index <18.5 kg/m2, lymphocyte count <1000 cells/μL, serum albumin levels <3.5 g/dL, and fibrocavitary disease. The areas under the receiver operating characteristic curves for the prognostic scoring model were 0.84 [95% confidence interval (CI), 0.80 - 0.89] for cohort 1 and 0.84 (95% CI, 0.75 - 0.92) for cohort 2. The 5-year OS rates of patients stratified into low-risk, intermediate-risk, and high-risk groups were 97.6, 76.6, and 30.8%, respectively (P < 0.001), in cohort 1, and 97.2, 82.3, and 45.4%, respectively (P < 0.001), in cohort 2.

Conclusions: This study is the first to develop and validate a prognostic scoring model for patients with MAC-LD. This model may prove useful in clinical settings and practical in estimating the prognosis.

Keywords: Bronchiectasis; Clinical epidemiology; Clinical respiratory medicine; Respiratory infections (non-tubeculous).

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Figures

Fig. 1
Fig. 1
Receiver operating characteristic curves for the prognostic scoring model predicting all-cause mortality for (a) cohort 1 and (b) cohort 2. AUC, area under the curve; 95% CI, 95% confidence interval
Fig. 2
Fig. 2
Kaplan-Meier analyses of overall survival and MAC-specific survival in (a, c) cohort 1 and (b, d) cohort 2 patients stratified into low-risk, intermediate-risk, and high-risk groups according to the prognostic scoring model. MAC, Mycobacterium avium complex
Fig. 3
Fig. 3
Impacts of treatment with more than one regimen on OS in each subgroup were shown in the forest plot
See this image and copyright information in PMC

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