https://scholars.lib.ntu.edu.tw/handle/123456789/512408
Title: | Outcome of patients with and poor prognostic factors for Mycobacterium kansasii-pulmonary disease | Authors: | CHIA-JUNG LIU Huang H.-L. Cheng M.-H. Lu P.-L. CHIN-CHUNG SHU JANN-YUAN WANG Chong I.-W. |
Issue Date: | 2019 | Publisher: | W.B. Saunders Ltd | Journal Volume: | 151 | Start page/Pages: | 19-26 | Source: | Respiratory Medicine | Abstract: | Background: Aggressive therapy for Mycobacterium kansasii-pulmonary disease (MK-PD) is recommended because of the virulence of MK. However, some clinicians may be concerned regarding the lengthy course and numerous adverse effects. This study evaluated the natural course of MK-PD and investigated its prognostic factors. Methods: Radiographic outcome, prognostic factors, and mortality within 1 year for MK-PD were obtained from patients in 6 hospitals in Taiwan from 2010 to 2014 (derivation cohort) and validated using patients in 2015 and 2016 (validation cohort). Results: Of the 109 patients with MK-PD in the derivation cohort, radiographic progression occurred in 70 (64%), with a 1-year mortality rate of 43% and median survival of 71 days, whereas none of the 39 cases without radiographic progression died. All patients with acid-fast smear (AFS) grade ? 3 experienced radiographic progression. For the others, the independent risk factors of radiographic progression were fibroCavitary pattern, Leucocyte count >9000/μL, Old age (age >65 years), pUre MK in sputum (no other mycobacteria), and no Diabetes mellitus (the CLOUD factors). By applying these criteria to the validation cohort (n = 112), 3 (9%) of the 33 patients with MK-PD who initially had AFS grade < 3 and < 3 CLOUD risk factors experienced radiographic progression, and none of the 3 died of MK-PD. Conclusions: Because of the high risk of radiographic progression and subsequent fatal outcome, immediate anti-MK treatment is recommended. For patients with MK-PD who have sputum AFS grade <3 and < 3 CLOUD risk factors, regular follow-up may be an alternative. ? 2019 The Author(s) |
URI: | https://www.scopus.com/inward/record.uri?eid=2-s2.0-85063662382&doi=10.1016%2fj.rmed.2019.03.015&partnerID=40&md5=2c4325ce7e33069df0a902a4dce1e0d2 https://scholars.lib.ntu.edu.tw/handle/123456789/512408 |
ISSN: | 0954-6111 | DOI: | 10.1016/j.rmed.2019.03.015 | SDG/Keyword: | acid fast smear; age; aged; Article; atypical mycobacteriosis; clinical article; cohort analysis; female; human; leukocyte count; lung infection; male; median survival time; mortality rate; Mycobacterium kansasii; nonhuman; outcome assessment; priority journal; prognostic assessment; retrospective study; risk factor; smear; sputum analysis; Taiwan; thorax radiography; atypical mycobacteriosis; body mass; diagnostic imaging; disease exacerbation; epidemiology; leukocytosis; lung disease; microbiology; mortality; prognosis; radiography; sputum; Age Factors; Aged; Body Mass Index; Cohort Studies; Disease Progression; Female; Humans; Leukocytosis; Lung Diseases; Male; Mycobacterium Infections, Nontuberculous; Mycobacterium kansasii; Prognosis; Radiography; Retrospective Studies; Risk Factors; Sputum; Taiwan |
Appears in Collections: | 醫學系 |
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