Predictors of mortality in chronic pulmonary aspergillosis

Abstract

Chronic pulmonary aspergillosis (CPA) is a chronic progressive infection that destroys lung tissue in non-immunocompromised patients. Contemporary series suggest 50-85% 5-year mortality, with few prognostic factors identified.A cohort of 387 CPA patients referred to the UK's National Aspergillosis Centre from 1992 to June 2012 was studied until June 2015. The impact of objective and subjective variables including age, sex, previous pulmonary conditions, dyspnoea score, quality of life, serum albumin and C-reactive protein and radiological appearances were assessed using Kaplan-Meier curves, log rank tests and Cox proportional hazards modelling. In samples of patients, retrospective review of time from likely onset of CPA to referral and cause of death were also investigated.Survival was 86%, 62% and 47% at 1, 5 and 10 years, respectively. Increased mortality was associated with nontuberculous mycobacterial infection (hazard ratio 2.07, 95% CI 1.22-3.52; p<0.001) and chronic obstructive pulmonary disease (1.57, 1.05-2.36; p=0.029) as well as higher age (1.053, 1.03-1.07 per year; p<0.001), lower albumin (0.92, 0.87-0.96 per g·L), lower activity (1.021, 1.01-1.03 per point increase in St George's Respiratory Questionnaire activity domain; p<0.001) and having one, and especially, bilateral aspergillomas (p<0.001).Several factors impact on mortality of CPA, and can be evaluated as tools to assess CPA prognosis.

Application of albumin/globulin ratio in elderly patients with acute exacerbation of chronic obstructive pulmonary disease

“…Patients with a high AGR and less severe clinical condition can move to low-level hospital to avoid over-treatment, which can effectively shorten the hospitalization time in high-level hospitals and reduce the loss of economic and social benefits. The serum albumin concentration is a prognostic factor in many lung diseases (24,25). We did not follow up on the prognosis of our patients, but early studies have shown that the AGR can be utilized to evaluate tumor prognosis (26,27).…”

Seroprevalence of Aspergillus IgG and disease prevalence of chronic pulmonary aspergillosis in a country with intermediate burden of tuberculosis: a prospective observational study

“…Chronic pulmonary aspergillosis (CPA) is an emerging global infectious disease, estimated to affect 3 million persons worldwide [1,2]. CPA also carries a high mortality and morbidity rate, with the 5-year mortality estimated to be 50e85% [3]. CPA is intertwined with TB disease, because the global TB burden remains large and prior TB is the single most important risk factor of CPA [1,4].…”

Positive Aspergillus PCR as a marker of azole resistance or sub‐therapeutic antifungal therapy in patients with chronic pulmonary aspergillosis

“…It is one of several respiratory diseases caused by the ubiquitous fungal genus, Aspergillus, of which A fumigatus is the most common human pathogen. CPA occurs mainly in immunocompetent patients with underlying respiratory conditions, including chronic obstructive pulmonary disease, sarcoidosis and previous Mycobacterium tuberculosis (MTB) infection . Globally, CPA is estimated to affect half a million people, producing a significant global health concern .…”

“…Globally, CPA is estimated to affect half a million people, producing a significant global health concern . Overall, the ten‐year mortality in patients affected by CPA exceeds 50% …”

“…Overall, the ten-year mortality in patients affected by CPA exceeds 50%. 2 Current guidelines suggest that radiological evidence is combined with a positive culture or Aspergillus-specific PCR (polymerase chain reaction), confirming the presence of Aspergillus in broncho-alveolar lavage (BAL) or sputum, or a positive serological response [specific IgG (immunoglobulin G) (>40 mg/L)]. 1 Radiologically, CPA can present as a single or multiple areas of cavitating consolidation with aspergillomata or, more rarely, as pulmonary Aspergillus nodules.…”