Baseline predictors influencing the prognosis of invasive aspergillosis in adults

Summary Invasive aspergillosis (IA) is a serious hazard to haematological and critical care patients. Impactful risk factors for developing IA have been characterised; however, systematic analysis of baseline prognostic factors for treatment course of IA is missing. To understand prognostic variable...

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Bibliographic Details
Published in:Mycoses 2019-08, Vol.62 (8), p.651-658
Main Authors: Koehler, Philipp, Salmanton‐García, Jon, Gräfe, Stefanie K., Koehler, Felix C., Mellinghoff, Sibylle C., Seidel, Danila, Steinbach, Angela, Cornely, Oliver A.
Format: Article
Language:English
Subjects:
Amphotericin B
Aspergillosis
Clinical trials
Corticosteroids
Diagnosis
disseminated disease
Family medical history
galactomannan
Graft-versus-host reaction
Immunosuppression
intensive care unit
invasive fungal disease
Liver diseases
Medical prognosis
Neutropenia
Patients
Pleural effusion
Renal failure
Risk factors
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Summary:Summary Invasive aspergillosis (IA) is a serious hazard to haematological and critical care patients. Impactful risk factors for developing IA have been characterised; however, systematic analysis of baseline prognostic factors for treatment course of IA is missing. To understand prognostic variables, we analysed original articles identifying baseline factors that predict treatment outcome in patients with IA. PubMed database was searched for publications since database inception until May 2018. Inclusion criteria were published baseline prognostic factors present at the diagnosis of IA. In total, 58 studies from 267 centres reported 7320 patients with IA and 40 different predictors. Unfavourable predictors in medical history were kidney (7.4%, 10/136) and liver failure (3.7%, 5/136), ICU admission (3.7%, 5/136) and uncontrolled underlying disease (3.7%, 5/136). Regarding state of immunosuppression, negative outcome predictors were prolonged neutropenia (12.5%, 17/136), corticosteroid treatment (8.1%, 11/136) and graft‐vs‐host disease (3.7%, 5/136). On the pathogen side, relevant predictors were galactomannan positivity (8.1%, 11/136), Aspergillus terreus infection (2.2%, 3/136) and lack of amphotericin B susceptibility (1.5%, 2/136). IA‐specific predictors were disseminated disease (5.1%, 7/136) and CNS involvement (2.9%, 4/136). Imaging results associated with negative outcome were multiple consolidations (2.9%, 4/136), bipulmonary lesions (2.2%, 3/136) and pleural effusion (2.2%, 3/136). At diagnosis of IA, most frequently identified predictors of outcome were neutropenia, corticosteroid use, elevated galactomannan, renal failure and disseminated disease. The predictors may be used to identify patients at high risk for treatment failure and to stratify neglected patient groups for clinical trials.
ISSN:0933-7407
1439-0507
DOI:10.1111/myc.12926