&lt;p&gt;Clinical Features and Co-Infections in Invasive Pulmonary Aspergillosis in Elderly Patients&lt;/p&gt;

Lao, Minxi; Zhang, Kaicong; Zhang, Meng; Wang, Qian; Li, Jin; Su, Lei; Ding, Mingchao; Wen, He; Gong, Yingying

doi:10.2147/idr.s273946

Cited by 5 publications

(7 citation statements)

References 39 publications

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“…The main research results are as follows: first, 27.4% patients died during the follow-up period, and comorbidities were more common among the patients who died. The all-cause mortality of patients with proven IPA in this study is similar to that reported in previous studies involving Chinese patients ( 7 , 8 ); second, chest CT showed that pulmonary consolidation and pleural effusion were more common in the non-survival group; third, advanced age (>60 years), increased CRP levels (>14.1 mg/L), undergoing chemotherapy, and presence of pleural effusion were risk factors for all-cause mortality in patients with proven IPA.…”

Section: Discussionsupporting

confidence: 90%

“…Advanced age and chemotherapy are correlated with the impairment of immune function. Therefore, they are recognized risk factors for infectious diseases, including aspergillosis ( 7 , 11 , 18 – 20 ). In this study, we also found that advanced age and chemotherapy increased the overall mortality of patients with proven IPA (HR: 10.7, CI: 2.5–44.9, P < 0.001; HR: 9.5, CI: 2.7–32.9, P < 0.001; respectively).…”

Section: Discussionmentioning

confidence: 99%

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

et al. 2021

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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.

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Section: Discussionsupporting

confidence: 90%

Section: Discussionmentioning

confidence: 99%

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

et al. 2021

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“…A retrospective cohort study showed that compared with P. aeruginosa infection alone, A. fumigatus and P. aeruginosa co-infection caused more rapid decline in patients with lung function and worsened clinical outcomes (28). Co-infection is closely associated with mortality (27).…”

Section: Co-infection With Aspergillosismentioning

confidence: 99%

“…A clue to co‐infection is that the proportion of pulmonary cavitation may be significantly higher in the co‐infection than in the fungal infection group. Lymphopenia could be an indicator for co‐infection in the elderly patients with IPA (27). Compared with a single pathogen infection, a differential immune response is mounted when patients are infected with multiple pathogens, and this may lead to different clinical outcomes.…”

Section: Co‐infection With Aspergillosismentioning

confidence: 99%

Invasive pulmonary aspergillosis in the intensive care unit: current challenges and best practices

Gaffney

Kelly

Rameli

et al. 2023

APMIS

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The prevalence of invasive pulmonary aspergillosis (IPA) is growing in critically ill patients in the intensive care unit (ICU). It is increasingly recognized in immunocompetent hosts and immunocompromised ones. IPA frequently complicates both severe influenza and severe coronavirus disease 2019 (COVID‐19) infection. It continues to represent both a diagnostic and therapeutic challenge and can be associated with significant morbidity and mortality. In this narrative review, we describe the epidemiology, risk factors and disease manifestations of IPA. We discuss the latest evidence and current published guidelines for the diagnosis and management of IPA in the context of the critically ill within the ICU. Finally, we review influenza‐associated pulmonary aspergillosis (IAPA), COVID‐19‐associated pulmonary aspergillosis (CAPA) as well as ongoing and future areas of research.

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“…IFDs caused by primary and opportunistic pathogens are identified among older individuals with immunosenescence 13 . Age is a significant predisposing factor for the development of fungal infection and is associated with increased mortality [14][15][16][17][18] . Comorbidities, increased use of corticosteroids and immunosuppressants, drug-drug interactions (DDIs) associated with polypharmacy,…”

mentioning

confidence: 99%

Post-hoc analysis of the safety and efficacy of isavuconazole in older patients with invasive fungal disease from the VITAL and SECURE studies

Hamed

Engelhardt

Kovanda

et al. 2023

Sci Rep

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Isavuconazole is a triazole with broad-spectrum antifungal activity. In this post-hoc analysis of two prospective clinical trials (VITAL and SECURE), the safety and efficacy of isavuconazole in patients aged ≥ 65 years with invasive fungal diseases were evaluated. Patients were divided into two subgroups (≥ 65 and < 65 years). Adverse events (AEs); all-cause mortality; and overall, clinical, mycological, and radiological response were assessed. A total of 155 patients ≥ 65 years were enrolled in both trials. Most patients reported AEs. In the isavuconazole arm of both studies, serious AEs (SAEs) were greater in patients ≥ 65 versus < 65 years: 76.7% versus 56.9% (VITAL); 61.9% versus 49.0% (SECURE). In SECURE, SAE rates were similar in the ≥ 65 years subgroup of both treatment arms (61.9% vs 58.1%), while in the < 65 years subgroup the SAE rate was lower in the isavuconazole arm (49.0% vs 57.4%). In VITAL, all-cause mortality through day 42 (30.0% vs 13.8%) was higher, and overall response at end of treatment (27.6% vs 46.8%) was lower in patients ≥ 65 years versus < 65 years. In SECURE, all-cause mortality was similar between both subgroups, and isavuconazole (20.6% vs 17.9%) and voriconazole (22.6% vs 19.4%) treatment arms. The overall response was lower in the ≥ 65 years than the < 65 years subgroup in the isavuconazole (23.7% vs 39.0%) and voriconazole (32.0% vs 37.5%) arms. The safety and efficacy of isavuconazole were better in patients < 65 versus ≥ 65 years, and the safety profile was more favorable than that of voriconazole in both subgroups.Clinicaltrials.gov identifier NCT00634049 and NCT00412893.

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<p>Clinical Features and Co-Infections in Invasive Pulmonary Aspergillosis in Elderly Patients</p>

Cited by 5 publications

References 39 publications

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

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

Invasive pulmonary aspergillosis in the intensive care unit: current challenges and best practices

Post-hoc analysis of the safety and efficacy of isavuconazole in older patients with invasive fungal disease from the VITAL and SECURE studies

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