Abstract
Invasive pulmonary aspergillosis (IPA) is an important cause of morbidity/mortality in critically ill patients with endstage liver disease. Therefore, aim of this study is to predict the prevalence and outcome of IPA in critically ill patients with underlying liver cirrhosis and evaluation of the necessity Glactomannan (GM) screening in serum and bronchoalveolar lavage (BAL) in this cohort. In total 12 out of 84 patients (14%) had probable IPA. The mean optical density index (ODI) bronchoalveolar lavage (BAL) GM index was 3.6 ± 1.5 (Range: 1.7–5.7). An overall sensitivity of 90% (95% CI 86–96%) and specificity of 85% (95% CI 81–88%) was found for the BAL GM in IPA. Acute Physiology And Chronic Health Evaluation (APACHE II), sequential organ failure assessment (SOFA) as well the model of endstage liver disease (MELD) score were significantly higher in the probable IPA group as compared to the No IPA group (26 versus 21, p < 0.001 and 14 versus 10, p < 0.044). Length of intensive care unit (ICU) stay was significantly longer in probable IPA patients (16 versus 10 days, p < 0.027) and mortality rate was significantly higher in probable IPA patients (100% versus 65%, p < 0.001) as compared to No IPA patients. APACHE II and MELD score were independently associated with higher mortality rate using multivariate logistic regression (p = 0.025 and p = 0.034). In conclusion, IPA has a relevant impact on outcome. Screening for IPA is indicated, easy to perform and a necessity to improve outcome.
Highlights
Invasive pulmonary aspergillosis (IPA) is commonly known as a severe opportunistic infection in immunocompromised patients[1]
A total of 84 critically ill patients with underlying liver cirrhosis were included in the study
Divided in patients with IPA and No IPA significant differences could be observed: Acute Physiology And Chronic Health Evaluation (APACHE) II, sequential organ failure assessment (SOFA) as well the model of endstage liver disease (MELD) score were significantly higher in the probable IPA group as compared to the No IPA group (26 versus 21, p < 0.001 and 14 versus 10, p < 0.044)
Summary
Invasive pulmonary aspergillosis (IPA) is commonly known as a severe opportunistic infection in immunocompromised patients[1]. IPA has been increasingly recognized in non –neutropenic critically ill patients as an emerging disease[2]. Till today mostly described in small studies and case series, end stage liver cirrhosis is poorly recognized as a relevant underlying disease for IPA3,4. It ist well known that invasive fungal infections lead to immunodeficiency based on various genetic influences but it affects the innate and adaptive immune systems[5]. Underlying host factors, and immunoregulatory abnormalities following critical illness and/or liver cirrhosis can induce a state of immunoparalysis[2,6]. The high incidence of infections may be explained by the so called cirrhosis associated immune dysfunction (CAID) which combines immunodeficiency and disturbance of specific immune system cells, including neutrophils and monocytes and T and B cells[6,7]
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