Association of adipokines with disease status and outcomes in patients with respiratory nontuberculous mycobacteria isolates

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Background: Underweight is a risk factor for nontuberculous mycobacterial lung disease (NTM-LD) and its progression, but mechanisms remain unclear. We hypothesize that underweight individuals have lower leptin and higher adiponectin levels, suppressing macrophage and T-cell activation, increasing susceptibility to NTM infection and progression. This study examines leptin and adiponectin levels in relation to NTM disease status (colonization or disease) and progression. Methods: Patients with respiratory NTM isolates were recruited from two hospitals. Serum adiponectin and leptin levels were measured via ELISA. NTM disease status was determined per guidelines. NTM-LD patients were followed for one year; progression was defined as microbiological persistence with radiographic worsening or antibiotic initiation. Results: We included 66 NTM-LD and 22 NTM-colonization patients. The NTM-LD group had higher adiponectin (13,681 vs. 5,733 ng/ml, P = 0.021) and lower leptin/adiponectin ratio (0.56 vs. 1.21, P = 0.023). The AUC for adiponectin and leptin/adiponectin ratio in predicting NTM disease status was 0.67 (95% CI: 0.53-0.81) and 0.67 (0.55-0.80). A leptin/adiponectin ratio >1.02 was linked to colonization (aOR = 4.83, 95% CI: 1.26-18.52). Among 66 NTM-LD patients, 30 showed progression. They had higher adiponectin (17,038 vs. 10,733 ng/ml, P = 0.002) and lower leptin/adiponectin ratio (0.43 vs. 0.96, P = 0.005). The AUC for predicting progression was 0.75 (0.61-0.88) and 0.73 (0.59-0.87). An adiponectin level >13,419 ng/ml was associated with progression (aOR = 4.21, 95% CI: 1.01-17.49). Conclusion: Adipokines help identify NTM status and progression.

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