Clinical Characteristics and Risk Factors for Chronic Pulmonary Aspergillosis in Patients with Nontuberculous Mycobacterial Pulmonary Disease

<b>Background:</b> The incidence of patients with nontuberculous mycobacterial pulmonary disease (NTM-PD) complicated by chronic pulmonary aspergillosis (CPA) has been increasing. CPA is known to be associated with complex treatment regimens and a poor prognosis. However, data from mainland China remain scarce. This single-center retrospective study aimed to evaluate the clinical characteristics, risk factors, and prognoses of patients with concurrent CPA and NTM-PD. <b>Methods:</b> We conducted a retrospective review of the medical records of 248 patients diagnosed with NTM-PD. Risk factors for CPA were analyzed via multiple logistic regression, followed by survival analysis. <b>Results:</b> Among the 248 patients with NTM-PD, 66 (26.6%) were diagnosed with CPA. Independent risk factors for NTM-PD and CPA coinfection included male sex (OR 2.13, 95% CI: 1.03-4.47), dyspnea (OR 27.9, 95% CI: 4.24-570), cavity (OR 5.95, 95% CI: 2.76-13.9), use of oral corticosteroids (OR 4.28, 95% CI: 1.13-16.6), and interstitial lung disease (OR 15.5, 95% CI: 1.89-361). The wide confidence intervals for some risk factors reflect limited precision. The Kaplan-Meier survival curves indicated a significant divergence between the NTM-PD group and the NTM-PD with CPA group (log-rank test, <i>p</i> = 0.00039). However, the adjusted hazard ratio was not statistically significant (HR 2.01, 95% CI: 0.66-6.12, <i>p</i> = 0.217). <b>Conclusions:</b> In patients with NTM-PD, the presence of concurrent CPA was associated with higher unadjusted mortality. Clinicians should maintain a high index of suspicion for CPA to ensure prompt diagnosis and treatment, particularly in high-risk individuals.