Disease Progression in Patients With Nontuberculous Mycobacterial Lung Disease of Nodular Bronchiectatic (NB) Pattern: The Roles of Cavitary NB and Soluble Programmed Death Protein-1

Sheng Wei Pan; Wei Juin Su; Yu Jiun Chan; Mei Lin Ho; Jia Yih Feng; Chin Chung Shu; Jann Yuan Wang; Hao Chien Wang; Chong Jen Yu; Yuh Min Chen

doi:10.1093/cid/ciab929

Disease Progression in Patients With Nontuberculous Mycobacterial Lung Disease of Nodular Bronchiectatic (NB) Pattern: The Roles of Cavitary NB and Soluble Programmed Death Protein-1

Clin Infect Dis. 2022 Aug 25;75(2):239-247. doi: 10.1093/cid/ciab929.

Authors

Sheng Wei Pan^{1

2

3}, Wei Juin Su^{2

4}, Yu Jiun Chan^{3

5

6}, Mei Lin Ho⁷, Jia Yih Feng^{1

2}, Chin Chung Shu^{8

9}, Jann Yuan Wang^{8

9}, Hao Chien Wang^{8

9

10}, Chong Jen Yu^{8

9

11}, Yuh Min Chen^{1

2}

Affiliations

¹ Department of Chest Medicine, Taipei Veterans General Hospital, Taipei, Taiwan.
² School of Medicine, National Yang Ming Chiao Tung University, Taipei, Taiwan.
³ Institute of Public Health, National Yang Ming Chiao Tung University, Taipei, Taiwan.
⁴ Division of Chest Medicine, China Medical University Hospital, Taipei Branch, Taipei, Taiwan.
⁵ Division of Infectious Diseases, Department of Medicine, Taipei Veterans General Hospital, Taipei, Taiwan.
⁶ Division of Microbiology, Department of Pathology and Laboratory Medicine, Taipei Veterans General Hospital, Taipei, Taiwan.
⁷ Department of Chemistry, Soochow University, Taipei, Taiwan.
⁸ Department of Internal Medicine, National Taiwan University Hospital, Taipei, Taiwan.
⁹ College of Medicine, National Taiwan University, Taipei, Taiwan.
¹⁰ Department of Medicine, National Taiwan University Cancer Center, Taipei, Taiwanand.
¹¹ Department of Internal Medicine, National Taiwan University Hospital, Hsin-Chu Branch, Hsin-Chu, Taiwan.

PMID: 34726741
DOI: 10.1093/cid/ciab929

Abstract

Background: In patients with nodular bronchiectatic (NB) nontuberculous mycobacterial lung disease (NTM-LD), risk factors for disease progression have not been clearly investigated. The roles of cavitary NB and soluble programmed death protein-1 (sPD-1), an immune-related biomarker, in the disease course of NB NTM-LD remain unknown.

Methods: Patients with NB NTM-LD were enrolled from 2 medical centers in 2014-2020. We identified cavitary NB, measured sPD-1 levels, and analyzed factors associated with cavitary NB and predictors for disease progression of NB NTM-LD.

Results: Of 120 cases of NB NTM-LD, 87 (72.5%) were caused by Mycobacterium avium complex. sPD-1 levels were lower in 13 (10.8%) patients with cavitary NB than in noncavitary patients (P = .020). Over 1.41 ± 1.43 years of follow-up, 12 (92.3%) patients in the cavitary and 66 (61.7%) in the noncavitary group developed disease progression (P = .032). In multivariable analysis, body mass index (BMI [kg/m2]; adjusted hazard ratio [aHR], .895 [95% confidence interval, .811-.988]), sputum smear grade (aHR, 1.247 [1.014-1.534]), cavitary NB (aHR, 2.008 [1.052-3.834]), and sPD-1 (per 10-pg/mL increase; aHR, .889 [.816-.967]) were predictive for disease progression. Notably, sPD-1 showed a dose-dependent association with disease progression (sPD-1 ≤23.5 pg/mL; aHR, 3.306 [1.664-6.567]; sPD-1: 23.6-53.7 pg/mL; aHR, 2.496 [1.390-4.483]) compared with the reference (sPD-1 >53.7 pg/mL).

Conclusions: Patients with NB NTM-LD and low sPD-1, low BMI, high smear grade, and cavitary NB were at high risk for disease progression. sPD-1 was low in patients with cavitary NB phenotype and dose-responsively associated with disease progression.

Keywords: cavity; disease progression; nodular bronchiectasis; nontuberculous mycobacterial lung disease (NTM-LD); soluble programmed death protein-1 (sPD-1).

Publication types

Research Support, Non-U.S. Gov't

MeSH terms

Bronchiectasis* / microbiology
Disease Progression
Humans
Lung Diseases* / microbiology
Mycobacterium Infections, Nontuberculous* / microbiology
Mycobacterium avium Complex
Pneumonia* / complications