Introduction

The lack of reliable predictors for the treatment response complicates decisions to initiate treatment in patients with Mycobacterium abscessus complex pulmonary disease (MABC-PD). We aimed to investigate whether baseline radiographic disease severity is associated with treatment outcome in MABC-PD.

Method

We retrospectively analyzed 101 patients with MABC-PD (54 with M. abscessus-PD and 47 with M. massiliense-PD) treated in a tertiary referral hospital between January 2006 and December 2019. Using chest computed tomography images, baseline radiographic disease severity was quantitatively scored according to five categories of radiographic lesions (bronchiectasis, bronchiolitis, cavities, nodules, and consolidation).

Results

Treatment success was achieved in 53.7% of patients with M. abscessus-PD and 85.1% of patients with M. massiliense-PD. Higher overall scores for baseline radiographic disease severity were associated with treatment failure in patients with M. massiliense-PD (aOR 1.35, 95% CI 1.02–1.79 for each 1-point increase in severity score), as well as in patients with M. abscessus-PD (aOR 1.15, 95% CI 1.00–1.33). This was particularly prominent in patients with overall severity score of ≥14 (aOR 31.16, 95% CI 1.12–868.95 for M. massiliense-PD and aOR 3.55, 95% CI 1.01–12.45 for M. abscessus-PD). Among variable radiographic abnormalities, the score for cavitary lesion severity was associated with treatment failure in patients with M. abscessus-PD (aOR 1.26, 95% CI 1.01–1.56), but not in patients with M. massiliense-PD.

Conclusions

Given the association between baseline radiographic disease severity and treatment outcome, initiating treatment should be actively considered before significant progression of radiographic lesions in patients with MABC-PD.

中文翻译：

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脓肿分枝杆菌复合肺病的影像学严重程度和治疗结果

介绍

治疗反应缺乏可靠的预测因子使脓肿分枝杆菌复合肺病 (MABC-PD) 患者开始治疗的决定变得复杂。我们旨在调查基线影像学疾病严重程度是否与 MABC-PD 的治疗结果相关。

方法

我们回顾性分析了 2006 年 1 月至 2019 年 12 月期间在三级转诊医院接受治疗的 101 名 MABC-PD 患者（54 名脓肿分枝杆菌-PD 和 47 名马氏分枝杆菌 -PD ）。使用胸部计算机断层扫描图像，基线影像学疾病严重程度为根据放射学病变的五类（支气管扩张、细支气管炎、空洞、结节和实变）进行定量评分。

结果

53.7% 的脓肿分枝杆菌-PD 患者和 85.1% 的马氏分枝杆菌 -PD患者取得了治疗成功。基线影像学疾病严重程度的总体评分较高与M. massiliense -PD患者的治疗失败相关（严重程度评分每增加 1 分，aOR 1.35，95% CI 1.02-1.79），以及M. massiliense 患者的治疗失败。脓肿-PD (aOR 1.15, 95% CI 1.00–1.33)。这在总体严重程度评分≥14 的患者中尤为突出（m . massiliense -PD 的 aOR 31.16, 95% CI 1.12–868.95 和脓肿分枝杆菌的 aOR 3.55, 95% CI 1.01–12.45-PD）。在可变的影像学异常中，空洞病变严重程度的评分与脓肿分枝杆菌-PD患者的治疗失败相关（aOR 1.26，95% CI 1.01-1.56），但与马氏分枝杆菌 -PD 患者的治疗失败无关。

结论

鉴于基线影像学疾病严重程度与治疗结果之间的关联，应在 MABC-PD 患者影像学病变显着进展之前积极考虑开始治疗。