Prognostic factors and outcomes of invasive pulmonary aspergillosis, a retrospective hospital-based study

• Published in: PeerJ (San Francisco, CA) Vol. 12; p. e17066
• Main Authors: Chen, Wei-Che, Chen, I-Chieh, Chen, Jun-Peng, Liao, Tsai-Ling, Chen, Yi-Ming
• Format: Journal Article
• Language: English
• Published: United States PeerJ, Inc 28.02.2024; PeerJ Inc
• Subjects: Antibiotics; Antigens; Aspergillosis; Blood diseases; Bronchus; Chronic obstructive pulmonary disease; Cirrhosis; Clinical outcomes; Codes; Comorbidity; Diabetes mellitus; Hematology; Hemodialysis; Hospitals; Immune system; Immunocompromised hosts; Immunosuppressive agents; Invasive pulmonary aspergillosis; Kidney transplantation; Lavage; Liver cirrhosis; Liver transplantation; Lungs; Malignancy; Medical imaging; Medical prognosis; Mortality; Neutropenia; Optical density; Patients; Renal failure; Renal replacement therapy; Respiratory failure; Risk factors; Stem cells; Steroids; Survival; Transplants & implants; Ventilators; Taiwan; Respiratory failure; Invasive pulmonary aspergillosis; Mortality; Risk factors; Renal failure
• ISSN: 2167-8359; 2167-8359
• DOI: 10.7717/peerj.17066

Invasive pulmonary aspergillosis (IPA) affects immunocompromised hosts and is associated with higher risks of respiratory failure and mortality. However, the clinical outcomes of different IPA types have not been identified. Between September 2002 and May 2021, we retrospectively enrolled patients with IPA in Taichung Veterans General Hospital, Taiwan. Cases were classified as possible IPA, probable IPA, proven IPA, and putative IPA according to EORTC/MSGERC criteria and the AspICU algorithm. Risk factors of respiratory failure, kidney failure, and mortality were analyzed by logistic regression. A total of 3-year survival was assessed by the Kaplan-Meier method with log-rank test for comparisons. We included 125 IPA patients (50: possible IPA, 47: probable IPA, 11: proven IPA, and 17: putative IPA). Comorbidities of liver cirrhosis and solid organ malignancy were risk factors for respiratory failure; diabetes mellitus and post-liver or kidney transplantation were related to kidney failure. Higher galactomannan (GM) test optical density index (ODI) in either serum or bronchoalveolar lavage fluid was associated with dismal outcomes. Probable IPA and putative IPA had lower 3-year respiratory failure-free survival compared to possible IPA. Probable IPA and putative IPA exhibited lower 3-year renal failure-free survival in comparison to possible IPA and proven IPA. Putative IPA had the lowest 3-year overall survival rates among the four IPA groups. Patients with putative IPA had higher mortality rates than the possible, probable, or proven IPA groups. Therefore, a prompt diagnosis and timely treatment are warranted for patients with putative IPA.