scholarly journals 1488. Relationship Between Culture Conversion and Clinical Outcomes in Patients With Mycobacterium abscessus (MAB) Lung Disease: A Systematic Literature Review

2020 ◽  
Vol 7 (Supplement_1) ◽  
pp. S746-S746
Author(s):  
Patrick A Flume ◽  
Kevin C Mange ◽  
Zhanna Jumadilova ◽  
Kristan B Cline ◽  
Kevin L Winthrop
Keyword(s):  
Quality Of Life ◽  
Lung Function ◽  
Literature Review ◽  
Lung Disease ◽  
Clinical Outcomes ◽  
Symptomatic Improvement ◽  
Symptom Improvement ◽  
Research Support ◽  
Culture Conversion

Abstract Background Treatment of MAB lung disease is difficult, and currently there is no consensus on the best course of treatment. We examined the relationship between culture conversion and clinical outcomes among patients with MAB lung disease. Methods English-language MAB lung disease studies with ≥10 patients and reporting culture conversion and/or an outcome of interest (eg, changes in symptoms, lung function, quality of life, and/or radiography) were identified from Embase, PubMed, relevant congress abstracts, and the Cochrane Library (data cutoff, September 24, 2019) using the National Institute for Health and Clinical Excellence guidance for systematic literature reviews. Two independent reviewers screened 1,551 indexed records; relevant data were extracted and are reported as population-weighted means. Results No study directly correlated culture conversion with a change in symptoms. In 10 studies (N=869) reporting overall symptoms and culture conversion separately, 72.5% of patients (range 36%–96%) reported symptom improvement and 56.5% (range, 13%-99%) achieved culture conversion; a weak trend between symptomatic improvement and higher culture conversion rates (R2=0.36) was observed. Three additional studies (N=106) reported symptomatic improvement and culture conversion as a single measurement (49.6%, range, 25%-81%). Limited data indirectly correlated improvement in cough, dyspnea, hemoptysis, sputum production, and fatigue with culture conversion (1-2 studies each). Two studies directly correlated improved lung function (N=62) with culture conversion, and one study indirectly reported improved health-related quality of life (N=47) with culture conversion; no study reported radiology outcomes in relation to culture conversion. Conclusion This systematic literature review underscores the lack of data correlating clinical outcomes and culture conversion in patients with MAB lung disease. Limitations include a small number of studies, inconsistencies/non-reporting of methods, and poorly defined outcomes. Although indirect data indicate a weak correlation between symptom improvement and culture conversion, more evidence is needed to demonstrate a clinical outcome benefit associated with culture conversion. Disclosures Patrick A Flume, MD, Insmed Incorporated (Grant/Research Support, Scientific Research Study Investigator, Advisor or Review Panel member) Kevin C Mange, MD, MSCE, Insmed Incorporated (Employee) Zhanna Jumadilova, MD, Insmed Incorporated (Employee) Kristan B Cline, PhD, Insmed Incorporated (Employee) Kevin L Winthrop, MD, MPH, Insmed Incorporated (Consultant, Grant/Research Support)

scholarly journals 1468. Culture Conversion and Mortality in Patients With Mycobacterium abscessus (MAB) Lung Disease: A Systematic Literature Review

2020 ◽  
Vol 7 (Supplement_1) ◽  
pp. S736-S736
Author(s):  
Kevin L Winthrop ◽  
Kevin C Mange ◽  
Zhanna Jumadilova ◽  
Kristan B Cline ◽  
Patrick A Flume
Keyword(s):  
Literature Review ◽  
Lung Disease ◽  
Systematic Literature Review ◽  
Panel Member ◽  
Cochrane Library ◽  
Attributable Mortality ◽  
Research Support ◽  
Persistent Symptoms ◽  
Conversion Rates ◽  
Culture Conversion

Abstract Background Prognosis for patients with MAB lung disease is poor. We sought to examine the potential association between culture conversion and outcomes (progression, mortality) in patients with MAB lung disease. Methods English-language MAB lung disease studies with ≥ 10 patients and reporting mortality and/or microbiological outcomes were identified from Embase, PubMed, relevant congress abstracts, and the Cochrane Library (data cutoff, September 24, 2019) using the National Institute for Health and Clinical Excellence guidance for systematic literature reviews. Two independent reviewers screened 1,551 indexed records; relevant extracted data are expressed as population-weighted means. Results Mean all-cause mortality across 17 studies (N=1,291) was 12.1% (range, 3%–33%); mortality attributable to MAB lung disease was 7.6% (range, 0%–27%; N=526, 9 studies). Culture conversion across 44 studies (N=2,237) was 46.7% (range, 0%–98.6%), with higher rates reported for M. massiliense subspecies (76.9%; N=507,15 studies) than M. abscessus subspecies (35.8%; N=834,18 studies). No direct comparisons were made between mortality and culture conversion; in the 13 studies (N=1,202) that reported both outcomes there was a moderate correlation between increased rate of culture conversion and decreased MAB-attributable mortality (R2=0.60). The most common definition of progression (21 studies) was radiographic worsening supported by persistent symptoms and/or positive cultures. Across 8 studies (N=415) 57.8% patients had improvement while 35.2% progressed with treatment. A broad variance in treatment regimen and duration (range, 32 days to > 3 years) was observed. Limitations include a small number of studies, and inconsistency in methods and outcomes definitions. Conclusion In this systematic literature review, available data suggest that culture conversion was achieved in less than half of patients and was lower in patients with M. abscessus compared with M. massiliense. One third of patients had disease progression despite treatment. Some data suggest lower MAB-attributed mortality outcomes in studies with higher culture conversion rates, more evidence is needed to demonstrate a survival benefit associated with culture conversion. Disclosures Kevin L Winthrop, MD, MPH, Insmed Incorporated (Consultant, Grant/Research Support) Kevin C Mange, MD, MSCE, Insmed Incorporated (Employee) Zhanna Jumadilova, MD, Insmed Incorporated (Employee) Kristan B Cline, PhD, Insmed Incorporated (Employee) Patrick A Flume, MD, Insmed Incorporated (Grant/Research Support, Scientific Research Study Investigator, Advisor or Review Panel member)

scholarly journals Determinants of health-related quality of life decline in interstitial lung disease

2020 ◽  
Vol 18 (1) ◽  
Author(s):  
Phillen Nozibuyiso Maqhuzu ◽  
Boglarka L. Szentes ◽  
Michael Kreuter ◽  
Thomas Bahmer ◽  
Nicolas Kahn ◽  
...  
Keyword(s):  
Quality Of Life ◽  
Interstitial Lung Disease ◽  
Lung Function ◽  
Lung Disease ◽  
Psychological Impact ◽  
Health Related Quality ◽  
Lower Baseline ◽  
Related Quality ◽  
Health Related

Abstract Background Health-related quality of life (HRQL) in interstitial lung disease (ILD) patients is impaired. We aimed to identify baseline predictors for HRQL decline within a 12-month observation period. Methods We analyzed 194 ILD patients from two German ILD-centers in the observational HILDA study. We employed the disease-specific King’s Brief Interstitial Lung Disease questionnaire (K-BILD) with the subdomains ‘psychological impact’, ‘chest symptoms’ and ‘breathlessness and activities’, and the generic EQ-5D Visual Analog Scale (VAS). We evaluated how many patients experienced a clinically meaningful decline in HRQL. Subsequently, we investigated medical and sociodemographic factors as potential predictors of HRQL deterioration. Results Within the study population (34.0% male, Ø age 61.7) mean HRQL scores hardly changed between baseline and follow up (K-BILD: 52.8 vs. 52.5 | VAS: 60.0 vs. 57.3). On the intra-individual level, 30.4% (n = 59) experienced a clinically relevant deterioration in K-BILD total score and 35.4% (n = 68) in VAS. Lower baseline forced vital capacity (FVC) % predicted determined HRQL decline in K-BILD total score (ß-coefficient: − 0.02, p = 0.007), VAS (ß-coefficient: − 0.03, p < 0.0001), and in the subdomain ‘psychological impact’ (ß-coefficient: − 0.02, p = 0.014). Lower baseline diffusing capacity of carbon monoxide (DLCO) % predicted determined deterioration in ‘breathlessness and activities’ (ß-coefficient: − 0.04, p = 0.003) and ‘chest symptoms’ (ß-coefficient: − 0.04, p = 0.002). Additionally, increasing age predicted decline in ‘psychological impact’ (ß-coefficient: 0.06, p < 0.007). Conclusion Around a third of ILD patients experienced a clinically relevant HRQL deterioration in a 12-month period, which was associated with baseline lung function values in all K-BILD domains. As lung function values are time-dependent variables with possible improvements, in contrast to age and ILD subtype, it, thus, seems important to improve lung function and prevent its decline in order to maintain HRQL on the possibly highest level.

scholarly journals Relationship Between Lung Function Impairment and Health-Related Quality of Life in COPD and Interstitial Lung Disease

CHEST Journal ◽  
2012 ◽  
Vol 142 (3) ◽  
pp. 704-711 ◽  
Author(s):  
Cristine E. Berry ◽  
M. Bradley Drummond ◽  
MeiLan K. Han ◽  
Daner Li ◽  
Cathy Fuller ◽  
...  
Keyword(s):  
Quality Of Life ◽  
Interstitial Lung Disease ◽  
Lung Function ◽  
Lung Disease ◽  
Health Related Quality ◽  
Function Impairment ◽  
Related Quality ◽  
Health Related ◽  
Lung Function Impairment

scholarly journals Determinants of health-related quality of life decline in interstitial lung disease

2020 ◽  
Author(s):  
Phillen Nozibuyiso Maqhuzu ◽  
Boglárka Lilla Szentes ◽  
Michael Kreuter ◽  
Thomas Bahmer ◽  
Nicolas Kahn ◽  
...  
Keyword(s):  
Quality Of Life ◽  
Interstitial Lung Disease ◽  
Lung Function ◽  
Lung Disease ◽  
Psychological Impact ◽  
Health Related Quality ◽  
Lower Baseline ◽  
Related Quality ◽  
Health Related

Abstract Background: Health-related quality of life (HRQL) in interstitial lung disease (ILD) patients is impaired. We aimed to identify baseline predictors for HRQL decline within a 12-month observation period. Methods: We analyzed 194 ILD patients from two German ILD-centers in the observational HILDA study. We employed the disease-specific King’s Brief Interstitial Lung Disease questionnaire (K-BILD) with the subdomains ‘psychological impact’, ‘chest symptoms’ and ‘breathlessness and activities’, and the generic EQ-5D Visual Analog Scale (VAS). We evaluated how many patients experienced a clinically meaningful decline in HRQL. Subsequently, we investigated medical and sociodemographic factors as potential predictors of HRQL deterioration. Results: Within the study population (34.0% male, Ø age 61.7) mean HRQL scores hardly changed between baseline and follow up (K-BILD: 52.8 vs. 52.5 | VAS: 60.0 vs. 57.3). On the intra-individual level, 30.4% (n = 59) experienced a clinically relevant deterioration in K-BILD total score and 35.4% (n = 68) in VAS. Lower baseline forced vital capacity % predicted determined HRQL decline in K-BILD total score (ß– coefficient -0.02, p = 0.007), VAS (ß–coefficient -0.03, p < 0.0001), and in the subdomain ‘psychological impact’ (ß– coefficient -0.02, p = 0.014). Lower baseline diffusing capacity of carbon monoxide % predicted determined deterioration in ‘breathlessness and activities’ (ß– coefficient -0.04, p = 0.003) and ‘chest symptoms’ (ß– coefficient -0.04, p = 0.002). Additionally, increasing age predicted decline in ‘psychological impact’ (ß–coefficient 0.06, p < 0.007). Conclusion: Around a third of ILD patients experienced a clinically relevant HRQL deterioration in a 12-month period, which is consistently associated with baseline lung function values. As lung function values are time-dependent variables with possible improvements, it, thus, seems important to diagnose ILD early in order to maintain HRQL on the possibly highest level.

scholarly journals Determinants of health-related quality of life decline in interstitial lung disease

2020 ◽  
Author(s):  
Phillen Nozibuyiso Maqhuzu ◽  
Boglárka Lilla Szentes ◽  
Michael Kreuter ◽  
Thomas Bahmer ◽  
Nicolas Kahn ◽  
...  
Keyword(s):  
Quality Of Life ◽  
Interstitial Lung Disease ◽  
Lung Function ◽  
Lung Disease ◽  
Psychological Impact ◽  
Health Related Quality ◽  
Lower Baseline ◽  
Related Quality ◽  
Health Related

Abstract Background: Health-related quality of life (HRQL) in interstitial lung disease (ILD) patients is impaired. We aimed to identify baseline predictors for HRQL decline within a 12-month observation period.Methods: We analyzed 194 ILD patients from two German ILD-centers in the observational HILDA study. We employed the disease-specific King’s Brief Interstitial Lung Disease questionnaire (K-BILD) with the subdomains ‘psychological impact’, ‘chest symptoms’ and ‘breathlessness and activities’, and the generic EQ-5D Visual Analog Scale (VAS). We evaluated how many patients experienced a clinically meaningful decline in HRQL. Subsequently, we investigated medical and sociodemographic factors as potential predictors of HRQL deterioration.Results: Within the study population (34.0% male, Ø age 61.7) mean HRQL scores hardly changed between baseline and follow up (K-BILD: 52.8 vs. 52.5 | VAS: 60.0 vs. 57.3). On the intra-individual level, 30.4% (n = 59) experienced a clinically relevant deterioration in K-BILD total score and 35.4% (n = 68) in VAS. Lower baseline forced vital capacity (FVC) % predicted determined HRQL decline in K-BILD total score (ß–coefficient: -0.02, p = 0.007), VAS (ß–coefficient: -0.03, p < 0.0001), and in the subdomain ‘psychological impact’ (ß–coefficient: -0.02, p = 0.014). Lower baseline diffusing capacity of carbon monoxide (DLCO) % predicted determined deterioration in ‘breathlessness and activities’ (ß– coefficient: -0.04, p = 0.003) and ‘chest symptoms’ (ß– coefficient: -0.04, p = 0.002). Additionally, increasing age predicted decline in ‘psychological impact’ (ß–coefficient: 0.06, p < 0.007).Conclusion: Around a third of ILD patients experienced a clinically relevant HRQL deterioration in a 12-month period, which was associated with baseline lung function values in all K-BILD domains. As lung function values are time-dependent variables with possible improvements, in contrast to age and ILD subtype, it, thus, seems important to improve lung function and prevent its decline in order to maintain HRQL on the possibly highest level.

Comorbid PTSD in Bipolar Patients: Clinical Outcomes and Quality of Life

2009 ◽  
Author(s):  
Lucas Quarantini ◽  
Angela Miranda-Scippa ◽  
Monica Nascimento ◽  
Flavio Kapczinski ◽  
Karestan Koenen
Keyword(s):  
Quality Of Life ◽  
Clinical Outcomes ◽  
Bipolar Patients
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