Prognostic factors in cavitary non-tuberculous mycobacterial pulmonary disease and proposal of Double-7 imaging pattern: A multicenter cohort study

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BACKGROUND: This study aimed to identify prognostic factors for cavitary nontuberculous mycobacterial pulmonary disease (NTM-PD) to enhance clinical management. METHODS: We retrospectively recruited patients with computed tomography-confirmed cavitary NTM-PD due to either Mycobacterium avium complex, Mycobacterium kansasii, or Mycobacterium abscessus complex in three medical centers in northern Taiwan during 2017 and 2021. We determined cutoffs for cavity features, including size and wall thickness, using receiver operating characteristic (ROC) curves analysis. The main outcome was overall survival. Secondary outcomes included catastrophic and unfavorable outcomes. RESULTS: Of 102 patients analyzed, cutoffs were set at 7 cm for cavity size and 7 mm for wall thickness. Thirteen patients (12.7 %) exceeded the size cutoff, and 15 (14.7 %) exceeded the wall thickness threshold. In multivariable analysis, the Double-7 pattern was associated with decreased overall survival (HR: 9.86, 95 % CI: 1.57-61.9, p = 0.0146), worse catastrophic outcome (HR 1.90, 95 % CI: 1.11-3.27, p = 0.0201) and poor unfavorable outcome (HR 1.82, 95 % CI: 1.09-3.04, p = 0.0216). CONCLUSIONS: Cavity size >7 cm or a cavity wall thickness >7 mm, referred to "Double-7 pattern" as a mnemonic, could be a simple and useful prognostic factor, in patients with cavitary NTM-PD.

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