Outcome and Risk Factors For Mortality In Critically Ill Patients With Invasive Pulmonary Aspergillosis

Ref ID: 18667

Author:

S. Blot, PhD – prof1, J. Rello, PhD – prof 2, G. Dimopoulos, PhD – prof 3, K. Vandewoude, PhD – prof 1, D. Vogelaers, PhD – prof 1, and the AspICU study investigators;

Author address:

1Ghent Univ, Gent, Belgium, 2Vall d’hebron Univ Hosp, Barcelona, Spain, 3Athens Attikon Univ. Hosp., Athens, Greece.

Full conference title:

52nd Annual ICAAC

Date: 9 September 2014

Abstract:

Background: Invasive pulmonary aspergillosis (IPA) has a bad prognosis. We investigated outcome and risk factors for IPA in a cohort of ICU patients with IPA. Methods: We performed a multicentre (n=30) observational cohort study (11/2006-01/2011) including ICU patients with ≥ 1 Aspergillus-positive culture (n=563). We selected patients with a diagnosis of proven (1), probable (1), or putative (2) IPA (n=278). Diagnoses were based on revised EORTC/Mycoses Study Group criteria (1) and a recently validated clinical algorithm (2). Results: The cohort included 83 cases of proven, 32 of probable, and 163 of putative IPA. Median (interquartile range) age was 64y (54-73), 81% had a medical ICU admission, and the median APACHE II score was 24 (17-29). Only 5% had no underlying conditions. Classic host factors (1) were present in 72%. Predominant underlying conditions were COPD (34%), malignancy (23%), and solid organ transplant (16%). The cohort was characterized by a high rate of organ failure at time diagnosis: median SOFA score 10 (6-13), 91% ventilator support, 68% vasopressive/inotropic support, 36% of renal replacement therapy. 12-week mortality was 71%. Non-survivors were older (64 vs 56y), had higher APACHE II scores (25 vs 21), more frequent a medical ICU admission (84 vs 72%), more chronic heart failure (12 vs 4%), more chronic dialysis (5 vs 0%), and more prolonged use of corticosteroids (53 vs 38%) (all p<0.05). At time of diagnosis, non-survivors had more ventilation support (94 vs 82%), asopressive/inotropic support (76 vs 51%), renal replacement therapy (42 vs 22%), and higher SOFA scores (11 vs 7). Independent predictors of mortality as identified by Cox regression were: medical ICU admission (hazard ratio (HR) 1.73; 95% confidence interval (CI) 1.17-2.56), older age (HR 1.01; 95% CI 1.00-1.02), and higher SOFA scores (HR 1.05; 1.02-1.08). Antifungal therapy did not alter the prognosis. Conclusions: Mortality in ICU patients with IPA is high. Older age and multiorgan failure indicate a worse prognosis. References. (1) De Pauw B, et al. Clin Infect Dis 2008 (2) Blot S, et al. Am J Respir Crit Care Med 2012.

Abstract Number: K-951

Conference Poster: y

Conference Year: 2012

Link to conference website: NULL

New link: NULL

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