Serum HMGB1 and CA19-9 are independently associated with pulmonary cavity formation in patients with non-tuberculous mycobacterial pulmonary disease.

OBJECTIVES: This work aimed to investigate the changes in serum inflammatory factors (IFs) in patients with nontuberculous mycobacterial pulmonary disease (NTM-PD) and to analyze their correlation with the presence of lung cavities. METHODS: A retrospective study was conducted on 80 NTM-PD patients and 80 non-active pulmonary tuberculosis (Non-ATB) controls. Clinical characteristics, NTM species distribution, and chest CT findings were analyzed. Serum levels of C-reactive protein (CRP), tumor necrosis factor-α (TNF-α), procalcitonin (PCT), interleukin-1 (IL-1), IL-6, IL-8, high mobility group box protein 1 (HMGB1), Cystatin C (Cys C), and carbohydrate antigen 19-9 (CA 19-9) were measured by ELISA. Correlations between IFs and cavitation were assessed using Spearman's test. RESULTS: Cavitation on CT was present in 31.2% of NTM-PD patients. Compared to Non-ATB controls, NTM-PD patients showed significantly higher levels of CRP, TNF-α, IL-6, HMGB1, Cys C, and CA19-9 (all P<0.05). Among NTM-PD patients, those with cavitation had significantly higher CRP, IL-6, IL-8, HMGB1, Cys C, and CA19-9 than those without cavitation (all P<0.05). Spearman analysis showed that cavitation positively correlated with CRP (r=0.284, P<0.05), IL-6 (r=0.195), IL-8 (r=0.189), HMGB1 (r=0.328), Cys C (r=0.272), and CA19-9 (r=0.312) (all P<0.05). ROC analysis revealed that the combination of HMGB1, CA19-9, and CRP yielded an AUC of 0.789 (95% CI: 0.672-0.906), with 76.0% sensitivity and 78.2% specificity. Multivariate logistic regression identified elevated HMGB1 (OR=1.142, 95% CI: 1.043-1.250, P=0.004), elevated CA19-9 (OR=1.067, 95% CI: 1.018-1.118, P=0.007), and coexisting bronchiectasis (OR=2.681, 95% CI: 1.076-6.684, P=0.034) as independent risk factors for cavitation. CONCLUSIONS: Serum HMGB1 and CA19-9 were independently associated with lung cavitation in NTM-PD patients and, together with CRP, may serve as non-invasive biomarkers for disease severity.