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

Wei-Che Chen; I-Chieh Chen; Jun-Peng Chen; Tsai-Ling Liao; Yi-Ming Chen

doi:10.7717/peerj.17066

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

PeerJ. 2024 Feb 28:12:e17066. doi: 10.7717/peerj.17066. eCollection 2024.

Authors

Wei-Che Chen¹, I-Chieh Chen², Jun-Peng Chen², Tsai-Ling Liao^{2

3}, Yi-Ming Chen^{2

3

4

5

6

7}

Affiliations

¹ Division of Nephrology, Department of Internal Medicine, Taichung Veterans General Hospital, Taiwan.
² Department of Medical Research, Taichung Veterans General Hospital, Taichung, Taiwan.
³ Institute of Biomedical Science and Rong-Hsing Research Center for Translational Medicine, National Chung Hsing University, Taichung, Taichung, Taiwan.
⁴ Division of Allergy, Immunology and Rheumatology, Taichung Veterans General Hospital, Taichung, Taiwan.
⁵ Department of Post-Baccalaureate Medicine, National Chung Hsing University, Taichung, Taichung, Taiwan.
⁶ Precision Medicine Research Center, National Chung Hsing University, Taichung, Taichung, Taiwan.
⁷ School of Medicine, National Yang-Ming Chiao Tung University, Taipei, Taiwan.

Abstract

Objective: 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.

Methods: 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 post-hoc comparisons.

Results: 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.

Conclusion: 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.

Keywords: Invasive pulmonary aspergillosis; Mortality; Renal failure; Respiratory failure; Risk factors.

MeSH terms

Hospitals, General
Humans
Invasive Pulmonary Aspergillosis* / diagnosis
Prognosis
Renal Insufficiency*
Respiratory Insufficiency* / epidemiology
Retrospective Studies

Grants and funding

This study was funded by the National Science and Technology Council, Taiwan (MOST 110-2314-B-075A-010, 110-2634-F-A49-005, NSTC 111-2314-B-005-007-MY3), the Academia Sinica, Taiwan (VTA111-V2-1-1), and the Taichung Veterans General Hospital, Taiwan TCVGH-1127301C, TCVGH-1127302D, TCVGH-YM1120110, TCVGH-1127304B and VTA113-V2-1-1. The funders had no role in study design, data collection and analysis, decision to publish, or preparation of the manuscript.