Clinical Characteristics and Prognostic Risk Factors of Patients With Proven Invasive Pulmonary Aspergillosis: A Single-Institution Retrospective Study

Abstract

Background: The mortality and burden of medical costs associated with invasive pulmonary aspergillosis (IPA) is very high. Currently, the clinical features and prognostic factors of patients with proven IPA are not very clear, especially in the Chinese population. In this retrospective analysis, we aimed to identify the clinical features and prognostic factors of patients with proven IPA.Methods: The diagnostic criteria for proven IPA were based on the international consensus of the EORTC/MSG. Data of patients with proven IPA at the West China Hospital of Sichuan University between January 2012 and December 2018 were collected. The optimal cut-off value of continuous variables was determined by Receiver Operating Characteristic curve and maximum Youden's index. Finally, using the Cox regression analysis to identify correlations between the clinical parameters associated with morbidity.Results: A total of 117 patients with proven IPA were included in the study, and 32 (27.4%) patients died during the follow-up period. Compared with the survivor group, elderly, patients with comorbidities, and patients undergoing chemotherapy and the level of inflammatory biomarkers [erythrocyte sedimentation rate, platelet count, interleukin-6, C-reactive protein (CRP)] in the non-survivor group were higher, while the albumin level was lower (P = 0.018). The imaging features were consolidation, nodules, cavities, pleural effusion, ground-glass shadows, and halo signs in order. Overall, 41.0% patients had mixed imaging features. The results suggested the most appropriate cut-off value of age and CRP were 60 years and 14.1 mg/L, respectively. The multivariate Cox regression analysis suggested that advanced age (>60 years) [hazard ratio (HR): 10.7, confidence interval (CI): 2.5–44.9, P < 0.001), undergoing chemotherapy (HR: 9.5, CI: 2.7–32.9, P < 0.001), presence of pleural effusion (HR: 5.74, CI: 1.6–20.8, P = 0.008), and increased CRP levels (>14.1 mg/L) (HR: 6.3, CI: 1.2–34.3, P = 0.033) were risk factors for all-cause mortality in patients with proven aspergillosis.Conclusions: This study showed that the prognosis of proven IPA is poor, and the age >60 years, undergoing chemotherapy, pleural effusion on CT image, and CRP levels >14.1 mg/L may be as risk factors for mortality in patients with proven IPA. large samples and real-world studies are needed to confirm these results in the future.

A score for predicting invasive pulmonary aspergillosis in immunocompetent critically ill patients

“…In patients with IPA, inhaled fungal spores activated resident cells and recruit inflammatory cells to initiate the secretion of cytokines and chemokines 13 . Previous studies also found that excessive pulmonary inflammation was correlated with IPA‐coinfection 14,15 . Additionally, malnutrition and hypoalbuminemia have already been reported as independent risk factors for IPA in critically ill patients 16,17 .…”

“…13 Previous studies also found that excessive pulmonary inflammation was correlated with IPA-coinfection. 14,15 Additionally, malnutrition and hypoalbuminemia have already been reported as independent risk factors for IPA in critically ill patients. 16,17 Recently, several novel inflammatory biomarkers, including the neutrophil-to-lymphocyte ratio (NLR), platelet-to-lymphocyte ratio (PLR), monocyte-tolymphocyte ratio (MLR), C-reactive protein-to-albumin ratio (CAR) and systemic immune-inflammation index (SII), have emerged as efficient predictors of various inflammatory and infectious diseases.…”

Aspergillus fumigatushypoxia adaptation is critical for the establishment of fungal keratitis

“…It is the predominant fungal pathogen of the lung, for example, where it can cause an allergic bronchopneumonia in atopic individuals or an invasive infection in those with severely compromised immune systems 1,2 . The latter disease, termed invasive pulmonary aspergillosis (IPA), carries a mortality rate of 40-90% depending on the extent of immune suppression or fungal dissemination to distal organs 3,4 . A. fumigatus is also an important cause of fungal keratitis (FK), a sight threatening infection of the cornea that can affect otherwise healthy individuals that are inoculated through ocular trauma or contact lens wear 5,6 .…”

In Vitro Susceptibilities of Worldwide Isolates of Intrapulmonary Aspergillus Species and Important Candida Species in Sterile Body Sites against Important Antifungals: Data from the Antimicrobial Testing Leadership and Surveillance Program, 2017–2020

“…Among the various kinds of fungal infections, invasive candidiasis and candidemia were ranked among the top 10 nosocomial infections in the last decade ( 1 ) and are notable invasive fungal diseases (IFD) that frequently cause high mortality rates ranging from 30% to 50% ( 2 , 3 ). Similarly, invasive pulmonary aspergillosis (IPA) has been reported to result in morbidities; particularly, 27.4% to 90% of IPA cases result in fatality, depending on the IPA severity and immune condition of patients ( 4 – 6 ). The incidence of IPA is increasing with the growing number of immunocompromised hosts, prescription of broad-spectrum antibacterial antibiotic(s) for prolonged durations in intensive care units, and patients with severe viral infections, such as influenza and COVID-19 ( 6 – 8 ).…”