Aspergillosis Case-Fatality Rate: Systematic Review of the Literature

• Published in: Clinical infectious diseases Vol. 32; no. 3; pp. 358 - 366
• Main Authors: Lin, Swu-Jane, Schranz, Jennifer, Teutsch, Steven M.
• Format: Journal Article
• Language: English
• Published: Chicago, IL The University of Chicago Press 01.02.2001; University of Chicago Press
• Subjects: Adolescent; Adult; Aged; Aged, 80 and over; AIDS; Amphotericin B - therapeutic use; Antifungal Agents - therapeutic use; Antifungals; Aspergillosis; Aspergillosis - complications; Aspergillosis - drug therapy; Aspergillosis - mortality; Aspergillus; Biological and medical sciences; Bone marrow; Bone marrow diseases; Bone Marrow Transplantation - mortality; Case-Control Studies; Central Nervous System Fungal Infections - mortality; Child; Child, Preschool; Clinical Trials as Topic; Cohort Studies; Drug Combinations; Female; Human mycoses; Humans; Infections; Infectious diseases; Lung diseases; Lungs; Major Article; Male; Medical sciences; MEDLINE; Middle Aged; Mortality; Mycoses; Mycoses of the respiratory system; Neutropenia - complications; Phosphatidylcholines - therapeutic use; Phosphatidylglycerols - therapeutic use; Prognosis; Infection; Human; Prognosis; Mycosis; Critically ill; Mortality; Aspergillosis; Risk factor; Definition; Review; Localization; Bibliographic review
• ISSN: 1058-4838; 1537-6591
• DOI: 10.1086/318483

To update the case-fatality rate (CFR) associated with invasive aspergillosis according to underlying conditions, site of infection, and antifungal therapy, data were systematically reviewed and pooled from clinical trials, cohort or case-control studies, and case series of ⩾10 patients with definite or probable aspergillosis. Subjects were 1941 patients described in studies published after 1995 that provided sufficient outcome data; cases included were identified by MEDLINE and EMBASE searches. The main outcome measure was the CFR. Fifty of 222 studies met the inclusion criteria. The overall CFR was 58%, and the CFR was highest for bone marrow transplant recipients (86.7%) and for patients with central nervous system or disseminated aspergillosis (88.1%). Amphotericin B deoxycholate and lipid formulations of amphotericin B failed to prevent death in one-half to two-thirds of patients. Mortality is high despite improvements in diagnosis and despite the advent of newer formulations of amphotericin B. Underlying patient conditions and the site of infection remain important prognostic factors.