Analysis on short-term prognosis and influencing factors of oral voriconazole in elderly patients with invasive pulmonary fungal infection

Abstract

Objective To explore the short-term prognosis and influencing factors of oral voriconazole in elderly patients with invasive pulmonary fungal infection (IPFI). Methods By searching hospital information system in Beijing Friendship Hospital, Capital Medical University, the medical records of elderly patients (≥80 years) who were diagnosed as IPFI and treated with oral voriconazole in Department of Geriatrics from January 2016 to December 2017 were collected and analyzed retrospectively. The basic information, basic diseases, combined medication, baseline value of liver and kidney function, treatment course of oral voriconazole, and liver and kidney function and survival status within 30 days after medication were recorded. The influencing factors of all-cause liver injury, acute renal injury (AKI), and death within 30 days after oral voriconazole were analyzed by multivariate logistic regression. The odds ratio (OR) and its 95% confidence interval (CI) were calculated. Results A total of 34 patients were entered, including 20 males and 14 females with age of (91±5) years. Of them, 6 patients (17.6%) developed liver injury, 7 patients (20.5%) developed AKI, and 9 patients (26.5%) died within 30 days after treatment with oral voriconazole. Multivariate logistic regression analysis showed that age was an independent risk factor for liver injury within 30 days after treatment with oral voriconazole (OR=1.33, 95%CI: 1.03-1.73, P=0.03), baseline estimated glomerular filtration rate (eGFR)<60 ml/ (min·1.73 m2) was an independent risk factor for AKI (OR=13.00, 95%CI: 1.27-133.29, P=0.03), AKI was an independent risk factor for death within 30 days (OR=48.00,95%CI: 4.21-547.18, P<0.01). Conclusions The risk of liver injury, AKI, and death was higher within 30 days after oral administration of voriconazole in elderly patients with IPFI. Age and baseline eGFR<60 ml/(min·1.73 m2) were independent risk factors for liver injury and AKI, respectively. AKI was an independent risk factor for death. Key words: Antifungal agents; Voriconazole; Aged, 80 and over; Lung diseases, fungal; Liver function tests; Kidney function tests; Death