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. 2018 May 3;18(1):206.
doi: 10.1186/s12879-018-3113-x.

High mortality in patients with Mycobacterium avium complex lung disease: a systematic review

Roland Diel  1   2 , Marc Lipman  3 , Wouter Hoefsloot  4
Affiliations

High mortality in patients with Mycobacterium avium complex lung disease: a systematic review

Roland Diel et al. BMC Infect Dis. .

Abstract

Background: The incidence of nontuberculous mycobacterial (NTM) pulmonary disease caused by Mycobacterium avium complex (MAC) in apparently immune-competent people is increasing worldwide. We performed a systematic review of the published literature on five-year all-cause mortality in patients with MAC lung disease, and pooled the mortality rates to give an overall estimate of five-year mortality from these studies.

Methods: We systematically reviewed the literature up to 1st August 2017 using PubMed® and ProQuest Dialog™ to search Medline® and Embase® databases, respectively. Eligible studies contained > 10 patients with MAC, and numerical five-year mortality data or a treatment evaluation for this patient group. Mortality data were extracted and analysed to determine a pooled estimate of all-cause mortality.

Results: Fourteen of 1035 identified studies, comprising 17 data sets with data from a total of 9035 patients, were eligible. The pooled estimate of five-year all-cause mortality was 27% (95% CI 21.3-37.8%). A high degree of heterogeneity was observed (I2 = 96%). The mortality in the data sets varied between 10 and 48%. Studies predominantly including patients with cavitary disease or greater comorbidity reported a higher risk of death. Patients in Asian studies tended to have a lower mortality risk. Predictors of mortality consistent across studies included male sex, presence of comorbidities and advanced patient age.

Conclusions: Despite high heterogeneity, most studies in patients with MAC pulmonary disease document a five-year all-cause mortality exceeding 25%, indicating poor prognosis. These findings emphasise the need for more effective management and additional prospective mortality data collection.

Keywords: Infectious disease; NTM; Nontuberculous mycobacteria; Survival outcome.

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Conflict of interest statement

Ethics approval and consent to participate

Not applicable.

Competing interests

RD has received fees for lecturing and consultancy from Insmed and Riemser. WH has received a research grant from Insmed. ML has nothing to disclose.

Publisher’s Note

Springer Nature remains neutral with regard to jurisdictional claims in published maps and institutional affiliations.

Figures

Fig. 1
Fig. 1
Flow chart describing the selection of studies and data sets included in the analysis.*Three of the identified publications contained data sets for two cohorts of patients, and these are considered separately here. MAC, Mycobacterium avium complex; NTM, nontuberculous mycobacterium
Fig. 2
Fig. 2
Analysis of five-year mortality in selected data sets. a Forest plot of five-year all-cause mortality rates in the identified data sets. Results are plotted ± 95% confidence interval (CI). b Funnel plot of five-year all-cause mortality versus standard error from selected data sets. BTS; The Research Committee of the British Thoracic Society
Fig. 3
Fig. 3
MAC-related five-year mortality and cavitary disease in selected data sets. a The proportion of all deaths related to MAC lung disease in the identified data sets. b Fibrocavitary disease and MAC-related five-year mortality. Black bars indicate fibrocavitary disease, grey bars indicate nodular/bronchiectatic disease. c Fibrocavitary disease and all-cause five-year mortality. Black bars indicate fibrocavitary disease, grey bars indicate nodular/bronchiectatic disease
See this image and copyright information in PMC

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