Cureus · 2025
Nutritional Status as a Risk Factor for the Early Discontinuation of Inhaled Liposomal Amikacin in Mycobacterium avium Complex Pulmonary Disease.
СтатьяНазвание и аннотация: Перевод в очереди
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Yamakawa Hideaki, Uzuka Chisa, Nakatani Daisuke, Nomaki Moe, Oba Tomohiro, Kawabe Rie, Sato Shintaro, Akasaka Keiichi, Amano Masako, Araya Jun, Matsushima Hidekazu
Аннотация
BACKGROUND: Pulmonary nontuberculous mycobacterial (NTM) disease, especially Mycobacterium avium complex pulmonary disease (MAC-PD), remains difficult to treat, with limited success and frequent adverse events. Amikacin liposome inhalation suspension (ALIS) is commonly used for refractory MAC-PD; however, early discontinuation in routine care is not uncommon. This study aimed to identify baseline clinical and nutritional factors associated with early ALIS discontinuation in real-world settings.
METHODS: We retrospectively analyzed patients with MAC-PD who received ALIS at Saitama Red Cross Hospital (November 2021-December 2024). Patients were categorized into early discontinuation (<6 months) and continuation (≥6 months) groups. Baseline data included age, sex, body mass index (BMI), albumin, comorbidities, pulmonary function, radiographic patterns, and co-infection status. Statistical tests included Welch's t-test, the Mann-Whitney U test, and Fisher's exact test.
RESULTS: Among 25 patients, 24% discontinued ALIS within six months. The early discontinuation group had significantly lower BMI (14.9±1.8 kg/m² vs. 19.0±3.3; p=0.002) and albumin (3.53±0.54 g/dL vs. 4.04±0.39; p=0.001). Fibrocavitary (FC) patterns were more frequent (50% vs. 11%; p=0.048). Adverse events were more common (p=0.042), with hemoptysis prominent. Other reasons included hoarseness, cough, fatigue, fever, dyspnea, ALIS-related hypersensitivity pneumonitis, and gastrointestinal symptoms.
CONCLUSIONS: Low BMI, hypoalbuminemia, and FC radiographic patterns were significant risk factors for early ALIS discontinuation. These findings emphasize that maintaining adequate nutritional status is a prerequisite for successful multidrug antimicrobial therapy for pulmonary NTM disease. Clinicians should carefully evaluate these factors before starting ALIS and ensure close monitoring and nutritional support to improve adherence and outcomes.
METHODS: We retrospectively analyzed patients with MAC-PD who received ALIS at Saitama Red Cross Hospital (November 2021-December 2024). Patients were categorized into early discontinuation (<6 months) and continuation (≥6 months) groups. Baseline data included age, sex, body mass index (BMI), albumin, comorbidities, pulmonary function, radiographic patterns, and co-infection status. Statistical tests included Welch's t-test, the Mann-Whitney U test, and Fisher's exact test.
RESULTS: Among 25 patients, 24% discontinued ALIS within six months. The early discontinuation group had significantly lower BMI (14.9±1.8 kg/m² vs. 19.0±3.3; p=0.002) and albumin (3.53±0.54 g/dL vs. 4.04±0.39; p=0.001). Fibrocavitary (FC) patterns were more frequent (50% vs. 11%; p=0.048). Adverse events were more common (p=0.042), with hemoptysis prominent. Other reasons included hoarseness, cough, fatigue, fever, dyspnea, ALIS-related hypersensitivity pneumonitis, and gastrointestinal symptoms.
CONCLUSIONS: Low BMI, hypoalbuminemia, and FC radiographic patterns were significant risk factors for early ALIS discontinuation. These findings emphasize that maintaining adequate nutritional status is a prerequisite for successful multidrug antimicrobial therapy for pulmonary NTM disease. Clinicians should carefully evaluate these factors before starting ALIS and ensure close monitoring and nutritional support to improve adherence and outcomes.