The Impacts of Aspergillosis on Outcome, Burden and Risks for Mortality in Influenza Patients with Critical Illness.

Chien-Ming Chao,Khee-Siang Chan,Chin-Ming Chen,Chun-Chieh Yang,Chung-Han Ho,Chih-Cheng Lai,Wen-Liang Yu,Hsuan-Fu Ou

doi:10.3390/jof7110922

Abstract

Previous studies have revealed higher mortality rates in patients with severe influenza who are coinfected with invasive pulmonary aspergillosis (IPA) than in those without IPA coinfection; nonetheless, the clinical impact of IPA on economic burden and risk factors for mortality in critically ill influenza patients remains undefined. The study was retrospectively conducted in three institutes. From 2016 through 2018, all adult patients with severe influenza admitted to an intensive care unit (ICU) were identified. All patients were classified as group 1, patients with concomitant severe influenza and IPA; group 2, severe influenza patients without IPA; and group 3, severe influenza patients without testing for IPA. Overall, there were 201 patients enrolled, including group 1 (n = 40), group 2 (n = 50), and group 3 (n = 111). Group 1 patients had a significantly higher mortality rate (20/40, 50%) than that of group 2 (6/50, 12%) and group 3 (18/11, 16.2%), p < 0.001. The risk factors for IPA occurrence were solid cancer and prolonged corticosteroid use in ICU of >5 days. Group 1 patients had significantly longer hospital stay and higher medical expenditure than the other two groups. The risk factors for mortality in group 1 patients included patients’ Charlson comorbidity index, presenting APACHE II score, and complication of severe acute respiratory distress syndrome. Overall, IPA has a significant adverse impact on the outcome and economic burden of severe influenza patients, who should be promptly managed based on risk host factors for IPA occurrence and mortality risk factors for coinfection with both diseases.

Highlights

Licensee MDPI, Basel, Switzerland.Invasive pulmonary aspergillosis (IPA) could be associated with high morbidity and mortality [1,2,3]
We recently reported an increasing trend of invasive pulmonary aspergillosis (IPA) over five years in southern Taiwan, which was epidemiologically correlated with the trends of influenza, especially influenza
We further investigated the impacts of IPA on the clinical outcomes of patients with severe influenza, which might help physicians to drive appropriate strategies in clinical pathways

Summary

Introduction

Licensee MDPI, Basel, Switzerland.Invasive pulmonary aspergillosis (IPA) could be associated with high morbidity and mortality [1,2,3]. Influenza itself is an independent risk factor of IPA and is associated with high mortality [7,8,9,10,11,12,13]. The impacts of IPA on the outcome of critically ill influenza patients remain variable around the world, probably due to inconsistent definitions and diagnostic criteria of IPA during clinical practice for managing influenza patients among different institutes. The host factors contributing to IPA in critically ill influenza patients and their mortality risk factors remain unidentified. We conducted a 3-year multicenter study to delineate the impacts of IPA on the clinical outcome and economic burden among influenza patients staying in ICUs. We aimed to identify the risk factors for IPA occurrence as well as the risk factors for mortality of IPA patients who have severe influenza

Methods

Results

Conclusion