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.
Highlights
Aspergillus spp. is ubiquitous in the environment
Proven invasive pulmonary aspergillosis (IPA) identification requires histopathological or cytopathological examination of a specimen obtained by needle aspiration or biopsy in which hyphae or melanized yeast-like forms are seen accompanied by evidence of associated tissue damage, or positive culture for Aspergillus from a sample obtained by sterile procedure from the lung [6]
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 computed tomography (CT) showed that pulmonary consolidation and pleural effusion were more common in the non-survival group; third, advanced age (>60 years), increased C-reactive protein (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
Summary
Aspergillus spp. is ubiquitous in the environment. The global burden of pulmonary aspergillosis cannot be underestimated. Invasive aspergillosis is the least common, with 0.2 million cases each year. It likely represents only 50–60% of actual cases [1]. Zilberberg et al showed that the hospital cost of patients with aspergillosis as the principal diagnosis increased from $440 million in 2004 to $590 million in 2013 after adjusting for inflation [3]. Despite the increased awareness, increasing number of susceptible individuals and subspecies, and improvement in antemortem diagnosis, China has reported a steady increase in the number of aspergillosis cases for decades [4]. The mortality and burden of medical costs associated with invasive pulmonary aspergillosis (IPA) is very high. The clinical features and prognostic factors of patients with proven IPA are not very clear, especially in the Chinese population. We aimed to identify the clinical features and prognostic factors of patients with proven IPA
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