Using routine blood parameters to anticipate clinical outcomes in invasive aspergillosis

Clin Microbiol Infect. 2020 Jun;26(6):781.e1-781.e8. doi: 10.1016/j.cmi.2019.10.019. Epub 2019 Oct 24.

Abstract

Objective: In invasive aspergillosis (IA), monitoring response to antifungal treatment is challenging. We aimed to explore if routine blood parameters help to anticipate outcomes following IA.

Methods: Post hoc secondary analysis of two multicenter randomized trials was performed. The Global Comparative Aspergillosis Study (GCA, n = 123) and the Combination Antifungal Study (CAS, n = 251) constituted the discovery and validation cohorts respectively. The outcome measures were response to treatment and survival to 12 weeks. Interval platelet, galactomannan index (GMI) and C-reactive protein (CRP) levels prior and during antifungal treatment were analysed using logistic regression, Kaplan-Meier survival and receiver operating characteristic (ROC) analyses.

Results: The 12-week survival was 70.7% and 63.7% for the GCA and CAS cohorts respectively. In the GCA cohort, every 10 × 109/L platelet count increase at week 2 and 4 improved 12-week survival odds by 6-18% (odds ratio (OR) 1.06-1.18, 95% confidence interval (CI) 1.02-1.33). Survival odds also improved 13% with every 10 mg/dL CRP drop at week 1 and 2 (OR 0.87, 95% CI 0.78-0.97). In the CAS cohort, week 2 platelet count was also associated with 12-week survival with 10% improved odds for every 10 × 109/L platelet increase (OR, 1.10, 95% CI 1.04-1.15). A GMI drop of 0.1 unit was additionally found to increase the odds of treatment response by 3% at the baseline of week 0 (OR 0.97, 95% CI 0.95-0.99). Week 2 platelet and CRP levels performed better than GMI on ROC analyses for survival (area under ROC curve 0.76, 0.87 and 0.67 respectively). A baseline platelet count higher than 30 × 109/L clearly identified patients with >75% survival probability.

Conclusions: Higher serial platelets were associated with overall survival while GMI trends were linked to IA treatment response. Routine and simple laboratory indices may aid follow-up of response in IA patients.

Keywords: C-reactive protein; Creatinine; Galactomannan; Leukemia; Platelet; Survival.

Publication types

  • Multicenter Study
  • Randomized Controlled Trial
  • Validation Study

MeSH terms

  • Adolescent
  • Adult
  • Aged
  • Antifungal Agents / therapeutic use*
  • Blood Chemical Analysis
  • C-Reactive Protein / analysis
  • Child
  • Cohort Studies
  • Female
  • Galactose / analogs & derivatives
  • Humans
  • Invasive Pulmonary Aspergillosis / blood*
  • Invasive Pulmonary Aspergillosis / drug therapy*
  • Male
  • Mannans / blood*
  • Middle Aged
  • Platelet Count
  • ROC Curve
  • Survival Analysis
  • Treatment Outcome
  • Young Adult

Substances

  • Antifungal Agents
  • Mannans
  • galactomannan
  • C-Reactive Protein
  • Galactose