Invasive pulmonary aspergillosis in cirrhotic patients: analysis of a 10-year clinical experience

Eric Levesque,Françoise Foulet,Noémie Clavieras,Nawel Ait-Ammar,Daniela Dudau,Françoise Botterel,Cyrille Feray

doi:10.1186/s13613-019-0502-2

Abstract

BackgroundCirrhosis is not recognised as one of the main risk factors of invasive pulmonary aspergillosis (IPA), although its prevalence is increasing. The aim of our study was to identify factors for IPA in such patients with a positive Aspergillus sp. culture in respiratory samples and to evaluate its impact on outcome.MethodsWe conducted a monocentric retrospective study between January 2005 and December 2015. All cirrhotic patients hospitalised in our liver ICU with a positive Aspergillus sp. respiratory sample were included. These patients were case-matched with cirrhotic patients without positive Aspergillus respiratory sample. Finally, the patients were classified as having putative aspergillosis or colonisation according to the criteria described previously.ResultsIn total, 986 cirrhotic patients were admitted to ICU during the study period. Among these, sixty patients had a positive Aspergillus sp. respiratory sample. Chronic obstructive pulmonary disease (COPD) comorbidity and organ supports were significantly associated with Aspergillus colonisation. Seventeen patients (28%) were diagnosed as proven or putative IPA and 43 were considered as colonised by Aspergillus sp. The median delay between ICU admission and an IPA diagnosis was 2 [2–24] days. Only COPD was predictive of the presence of IPA (OR 6.44; 95% CI 1.43–28.92; p = 0.0151) in patients with a positive Aspergillus sp. culture. The probability of in-hospital mortality was 71% in the IPA group versus 19% in the colonisation group (p = 0.0001).ConclusionPatients with cirrhosis can be at risk of IPA, especially with COPD. Antifungal agents should be given as soon as possible mainly in cirrhotic patients with COPD.

Highlights

Patients with cirrhosis are at risk of developing infection, sepsis and sepsis-induced organ failure [1]
Risk factors for colonisation A total of 362 samples have been performed in the two cohorts with a rate of positivity of 17.4% (63/362 samples)
Under multivariate regression logistic analysis, only chronic obstructive pulmonary disease (COPD) was predictive of the presence of invasive pulmonary aspergillosis (IPA) in patients with a positive Aspergillus sp. culture

Summary

Introduction

Patients with cirrhosis are at risk of developing infection, sepsis and sepsis-induced organ failure [1]. About 30% of cirrhotic patients admitted to an intensive care unit (ICU) have acquired or will acquire infections, most frequently involving the respiratory tract, urinary tract or ascites [2]. This high incidence of infection can partly be explained by cirrhosis-associated immune dysfunction. This state of immunodeficiency is a complex multifactorial process resulting from bacterial translocation, with the continuous stimulation of immune system cells, Levesque et al Ann. Intensive Care (2019) 9:31 population [9, 10, 15]. The aim of our study was to identify factors for IPA in such patients with a posi‐ tive Aspergillus sp. culture in respiratory samples and to evaluate its impact on outcome

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