非结核性分枝杆菌肺病患者的临床显著咯血和全因死亡率

IF 3.5 3区医学 Q2 CARDIAC & CARDIOVASCULAR SYSTEMS

Respiratory medicine Pub Date : 2025-02-01 DOI:10.1016/j.rmed.2025.107946

Kwonhyung Hyung , Sung A Kim , Nakwon Kwak , Jae-Joon Yim , Joong-Yub Kim

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引用次数: 0

摘要

背景：咯血是非结核性分枝杆菌肺病（NTM-PD）患者的主要症状之一。然而，其患病率、发病率和对长期预后的影响仍不确定。我们评估了临床显著咯血的发生率，并确定了其与NTM-PD患者死亡率的关系。方法：对2011年7月至2023年5月纳入前瞻性观察队列（NCT01616745）的患者进行分析。我们评估了临床上明显咯血的危险因素——定义为需要支气管动脉栓塞或手术切除等干预措施的咯血事件——及其与全因死亡率的关系。结果：在正在进行的队列中的506名患者中，43名患者（8.5%）在中位随访5.1年期间出现临床显著咯血。临床显著咯血的总发生率为2.1(95%可信区间[CI]；每100人年1.5-2.9例。确定的危险因素包括结核病史(发病率比[IRR]， 1.91；95% CI, 1.02-3.60)，升高的c反应蛋白（CRP） (IRR， 1mg/dl升高1.20；95% CI, 1.01-1.43)，预测强迫肺活量（FVC）的百分比更低（IRR, 0.81）；95% ci, 0.66-0.98)。临床显著咯血与全因死亡风险增加独立相关(校正风险比，2.39；95% ci, 1.31-4.36)。结论：在NTM-PD患者中，有结核病史、CRP水平较高、FVC预测值较低的患者发生临床显著咯血的风险较高。重要的是，临床上显著的咯血与全因死亡风险升高相关。临床试验注册：ClinicalTrials.gov；否。: NCT01616745。

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Clinically significant hemoptysis and all-cause mortality in patients with nontuberculous mycobacterial pulmonary disease

Background

Hemoptysis is one of the major symptoms in patients with nontuberculous mycobacterial pulmonary disease (NTM-PD). However, its prevalence, incidence, and impact on long-term prognosis remain uncertain. We evaluated the incidence of clinically significant hemoptysis, and determined its association with mortality in patients with NTM-PD.

Methods

Patients enrolled in a prospective observational cohort (NCT01616745) between July 2011 and May 2023 were analyzed. We evaluated risk factors for clinically significant hemoptysis—defined as hemoptysis events requiring interventions such as bronchial artery embolization or surgical resection—and its association with all-cause mortality.

Results

Among 506 patients from the ongoing cohort, 43 patients (8.5 %) experienced clinically significant hemoptysis during a median follow-up of 5.1 years. The overall incidence of clinically significant hemoptysis was 2.1 (95 % confidence interval [CI]; 1.5–2.9) cases per 100 person-years. Identified risk factors included a history of tuberculosis (incidence rate ratio [IRR], 1.91; 95 % CI, 1.02–3.60), higher C-reactive protein (CRP) (IRR, 1.20 for 1 mg/dl increase; 95 % CI, 1.01–1.43), and lower % predicted forced vital capacity (FVC) (IRR, 0.81 for 10 % increase; 95 % CI, 0.66–0.98). Clinically significant hemoptysis was independently associated with an increased risk of all-cause mortality (adjusted hazard ratio, 2.39; 95 % CI, 1.31–4.36).

Conclusion

In patients with NTM-PD, those with history of tuberculosis, higher CRP levels, and lower % predicted FVC were at a higher risk of subsequent clinically significant hemoptysis. Importantly, clinically significant hemoptysis was associated with an elevated risk of all-cause mortality.

Clinical trial registration

ClinicalTrials.gov; No.: NCT01616745.

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来源期刊

Respiratory medicine 医学-呼吸系统

CiteScore

7.50

自引率

0.00%

发文量

199

审稿时长

38 days

期刊介绍： Respiratory Medicine is an internationally-renowned journal devoted to the rapid publication of clinically-relevant respiratory medicine research. It combines cutting-edge original research with state-of-the-art reviews dealing with all aspects of respiratory diseases and therapeutic interventions. Topics include adult and paediatric medicine, epidemiology, immunology and cell biology, physiology, occupational disorders, and the role of allergens and pollutants. Respiratory Medicine is increasingly the journal of choice for publication of phased trial work, commenting on effectiveness, dosage and methods of action.