Prevalence and outcome of invasive pulmonary aspergillosis in critically ill patients with liver cirrhosis: an observational study

Lahmer, Tobias; Brandl, Andreas; Rasch, Sebastian; Baires, Gonzalo Batres; Schmid, Roland M.; Huber, Wolfgang; Mayr, Ulrich

doi:10.1038/s41598-019-48183-4

Cited by 27 publications

(28 citation statements)

References 26 publications

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“…Several studies have been conducted in intensive care units and identified, in the absence of malignancy, HSCT, or solid organ transplantations, the following risk factors for IA: severe chronic obstructive pulmonary disease, steroid therapy, HIV infection, influenza virus infection (especially H1N1), chronic renal replacement therapy, liver failure, near-drowning, prolonged period of mechanical ventilator dependency. 25,[97][98][99][100][101][102][103][104][105][106][107][108][109][110][111][112][113] Irrespective of these comorbidities, immune paralysis (also called compensatory antiinflammatory response syndrome) induced by severe sepsis can by itself be a risk factor for IA. 114,115 Recently several cases of IA have been reported in patients suffering from severe fever with thrombocytopenia syndrome virus infection, a tick-born disease present in China, Korea, Vietnam, and Japan.…”

Section: Critically Ill Patientsmentioning

confidence: 99%

Invasive Pulmonary Aspergillosis

Ledoux

Guffroy

Nivoix

et al. 2020

Semin Respir Crit Care Med

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Invasive pulmonary aspergillosis (IPA) remains difficult to diagnose and to treat. Most common risk factors are prolonged neutropenia, hematopoietic stem cell or solid organ transplantation, inherited or acquired immunodeficiency, administration of steroids or other immunosuppressive agents including monoclonal antibodies and new small molecules used for cancer therapy. Critically ill patients are also at high risk of IPA. Clinical signs are unspecific. Early computed tomography (CT)-scan identifies the two main aspects, angioinvasive and airway invasive aspergillosis. Although CT-scan findings are not fully specific they usually allow early initiation of therapy before mycological confirmation of the diagnosis. Role of 18F-fludeoxyglucose positron emission tomography with computed tomography (18F-FDG PET/CT) is discussed. Confirmation is based on microscopy and culture of respiratory samples, histopathology in case of biopsy, and importantly by detection of Aspergillus galactomannan using an immunoassay in serum and bronchoalveolar lavage fluid. Deoxyribonucleic acid detection by polymerase chain reaction is now standardized and increases the diagnosis yield. Two point of care tests detecting an Aspergillus glycoprotein using a lateral flow assay are also available. Mycological results allow classification into proven (irrespective of underlying condition), probable or possible (for cancer and severely immunosuppressed patients) or putative (for critically ill patients) IPA. New antifungal agents have been developed over the last 2 decades: new azoles (voriconazole, posaconazole, isavuconazole), lipid formulations of amphotericin B (liposomal amphotericin B, amphotericin B lipid complex), echinocandins (caspofungin, micafungin, anidulafungin). Results of main trials assessing these agents in monotherapy or in combination are presented as well as the recommendations for their use according to international guidelines. New agents are under development.

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Section: Critically Ill Patientsmentioning

confidence: 99%

Invasive Pulmonary Aspergillosis

Ledoux

Guffroy

Nivoix

et al. 2020

Semin Respir Crit Care Med

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“…IFIs in CP-C patients are probably caused by their immunocompromised state and the application of a large number of steroids and broad-spectrum antimicrobial agents, as well as invasive procedures [ 6 ]. It takes a heavy toll on outcomes with high in-hospital mortality rates if not promptly recognized and treated [ 7 , 8 ], ascribed to the rapid progression with a lung infection and even septic shock [ 6 , 9 , 10 ].…”

Section: Introductionmentioning

confidence: 99%

Predictors of Voriconazole Trough Concentrations in Patients with Child–Pugh Class C Cirrhosis: A Prospective Study

et al. 2021

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This prospective observational study aimed to clinically describe voriconazole administrations and trough concentrations in patients with Child–Pugh class C and to investigate the variability of trough concentration. A total of 144 voriconazole trough concentrations from 43 Child–Pugh class C patients were analyzed. The majority of patients (62.8%) received adjustments. The repeated measured trough concentration was higher than the first and final ones generally (median, 4.33 vs. 2.99, 3.90 mg/L). Eight patients with ideal initial concentrations later got supratherapeutic with no adjusted daily dose, implying accumulation. There was a significant difference in concentrations among the six groups by daily dose (p = 0.006). The bivariate correlation analysis showed that sex, CYP2C19 genotyping, daily dose, prothrombin time activity, international normalized ratio, platelet, and Model for end-stage liver disease score were significant factors for concentration. Subsequently, the first four factors mentioned above entered into a stepwise multiple linear regression model (variance inflation factor <5), implying that CYP2C19 testing makes sense for precision medicine of Child–Pugh class C cirrhosis patients. The equation fits well and explains the 34.8% variety of concentrations (R2 = 0.348). In conclusion, it needs more cautious administration clinically due to no recommendation for Child–Pugh class C patients in the medication label. The adjustment of the administration regimen should be mainly based on the results of repeated therapeutic drug monitoring.

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“…Cirrhosis alters the function of circulating immune cells and impairs the synthesis of innate immunity proteins (such as complement) and secreted pattern-recognition receptors (e.g., C-reactive protein, lipopolysaccharide-binding protein, and soluble CD14) [ 30 , 31 ]. Cirrhosis has been described as a risk factor for cryptococcosis [ 32 ], aspergillosis [ 31 , 33 ], and CM [ [34] , [35] , [36] , [37] , [38] ]. Blair and coworkers found that end-stage liver disease (ESLD) increased the risk of acquisition of CM by 100-fold, based on a group of ESLD patients living in a high-risk area (Arizona) awaiting liver transplantation [ 36 ].…”

Section: Discussionmentioning

confidence: 99%