Objective  To investigate the mortality of pulmonary disease caused by Mycobacterium avium complex (MAC).

  Methods  Relevant publications were collected by literature retrieval from Medline, Cochrane, Embase and Web of Science between January 1, 1941 and January 1, 2020. Two investigators screened 1 622 articles, and 48 articles were finally included according to the inclusion and exclusion criteria. Quality of included researches was evaluated by using Newcastle-Ottawa scale (NOS) and Cochrane risk of bias tool. Meta-analysis was performed on the original data by using RevMan5.3 and Stata14.0.

  Results  Forty eight studies, including 45 cohort studies and 3 random clinical trials and involving 6 933 cases of MAC pulmonary disease, were used, in which 31 studies reported causative mortality rate of MAC pulmonary diseases and 14 studies reported five-year all-cause mortality of MAC pulmonary diseases. This Meta-analysis indicated that all-cause mortality rate of MAC pulmonary diseases was 20.00% (I²=95.00%), five-year all-cause mortality rate was 26.00%(I²=94.00%), and the causative mortality rate was 5.00% (I²=87.00%). The prognostic factors included cavity type in radiography, age ≥65 years, being male, comorbidities, BMI ≤18.50 kg/m² and ALB <3.50 g/dL. The subgroup analysis showed that the patients with HIV infection, cavity and comorbidities had higher overall mortality rates.

  Conclusion  This meta-analysis revealed that all-cause mortality rate of MAC pulmonary diseases was high and the patients had poor prognosis. The patients with HIV infection, cavity and comorbidities had increased risk of death.