Invasive Pulmonary Aspergillosis in Patients with Acute-on-chronic Liver Failure

Abstract

Patients with acute-on-chronic liver failure (AoCLF) are prone to various infections, including invasive pulmonary aspergillosis (IPA). This retrospective study investigated the relationship between AoCLF and IPA in a large patient cohort. Twenty-nine out of 470 patients with AoCLF, who were diagnosed with definite or probable IPA by clinical and laboratory parameters and were treated with voriconazole, were analysed for predisposing factors for IPA and clinical outcome. Imaging findings, such as the halo sign and increased white blood cell count, contributed to the early diagnosis of IPA. Patients with AoCLF and IPA experienced fever, cough and chest pain and, despite treatment with antifungal therapy, most (25/29 patients) died within 7 days. Possible risk factors for IPA included prolonged antibiotic therapy and dexamethasone exposure. AoCLF with prolonged antibiotic therapy and dexamethasone exposure carries a high risk for IPA. AoCLF patients with IPA involved in this study exhibited fever, cough, chest pain and increased white blood cell count, and their imaging findings were useful for the early diagnosis of IPA.