Epidemiology of invasive pulmonary aspergillosis in patients with liver failure: Clinical presentation, risk factors, and outcomes

Zhang, Xuan; Yang, Meifang; Hu, Jianhua; Li, Lanjuan

doi:10.1177/0300060517729907

Cited by 21 publications

(18 citation statements)

References 27 publications

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“…Critically ill patients experiencing liver failure are also at risk for aspergillosis, as shown by Zhang et al 62 with an incidence of 5% of IPA in this setting. Steroids, antibiotics, and hepatorenal syndrome are frequent under this condition and each one is an independent risk factor for IPA in this population.…”

Section: Liver Failurementioning

confidence: 91%

Invasive Pulmonary Aspergillosis in Nonimmunocompromised Hosts

Tudesq

Peyrony

Lemiale

et al. 2019

Semin Respir Crit Care Med

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Invasive pulmonary aspergillosis (IPA) is a fungal infection that is the hallmark of severe cellular or complex immune alterations. Evidence that IPA can occur in nonimmunocompromised hosts is increasing. Actually, up to 1% of general intensive care unit (ICU) patients present positive samples with Aspergillus spp. Both colonization and invasive disease are associated with poor outcome. Unexpected IPA has also been reported in approximately 1% of critically ill patients who underwent postmortem biopsies. In nonimmunocompromised patients with acute respiratory distress syndrome (ARDS), IPA prevalence can reach up to 15% of patients in both clinical and autopsy studies. Factors associated with IPA in nonimmunocompromised critically ill hosts include short and long courses of steroids, broad antibiotic therapy, chronic obstructive pulmonary disease, ARDS, liver failure, and the severity of organ dysfunctions.This review aims to appraise the prevalence of IPA in nonimmunocompromised hosts, address diagnostic challenges, and outcomes.

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Section: Liver Failurementioning

confidence: 91%

Invasive Pulmonary Aspergillosis in Nonimmunocompromised Hosts

Tudesq

Peyrony

Lemiale

et al. 2019

Semin Respir Crit Care Med

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“…Several studies have been conducted in intensive care units and identified, in the absence of malignancy, HSCT, or solid organ transplantations, the following risk factors for IA: severe chronic obstructive pulmonary disease, steroid therapy, HIV infection, influenza virus infection (especially H1N1), chronic renal replacement therapy, liver failure, near-drowning, prolonged period of mechanical ventilator dependency. 25,[97][98][99][100][101][102][103][104][105][106][107][108][109][110][111][112][113] Irrespective of these comorbidities, immune paralysis (also called compensatory antiinflammatory response syndrome) induced by severe sepsis can by itself be a risk factor for IA. 114,115 Recently several cases of IA have been reported in patients suffering from severe fever with thrombocytopenia syndrome virus infection, a tick-born disease present in China, Korea, Vietnam, and Japan.…”

Section: Critically Ill Patientsmentioning

confidence: 99%

Invasive Pulmonary Aspergillosis

Ledoux

Guffroy

Nivoix

et al. 2020

Semin Respir Crit Care Med

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Invasive pulmonary aspergillosis (IPA) remains difficult to diagnose and to treat. Most common risk factors are prolonged neutropenia, hematopoietic stem cell or solid organ transplantation, inherited or acquired immunodeficiency, administration of steroids or other immunosuppressive agents including monoclonal antibodies and new small molecules used for cancer therapy. Critically ill patients are also at high risk of IPA. Clinical signs are unspecific. Early computed tomography (CT)-scan identifies the two main aspects, angioinvasive and airway invasive aspergillosis. Although CT-scan findings are not fully specific they usually allow early initiation of therapy before mycological confirmation of the diagnosis. Role of 18F-fludeoxyglucose positron emission tomography with computed tomography (18F-FDG PET/CT) is discussed. Confirmation is based on microscopy and culture of respiratory samples, histopathology in case of biopsy, and importantly by detection of Aspergillus galactomannan using an immunoassay in serum and bronchoalveolar lavage fluid. Deoxyribonucleic acid detection by polymerase chain reaction is now standardized and increases the diagnosis yield. Two point of care tests detecting an Aspergillus glycoprotein using a lateral flow assay are also available. Mycological results allow classification into proven (irrespective of underlying condition), probable or possible (for cancer and severely immunosuppressed patients) or putative (for critically ill patients) IPA. New antifungal agents have been developed over the last 2 decades: new azoles (voriconazole, posaconazole, isavuconazole), lipid formulations of amphotericin B (liposomal amphotericin B, amphotericin B lipid complex), echinocandins (caspofungin, micafungin, anidulafungin). Results of main trials assessing these agents in monotherapy or in combination are presented as well as the recommendations for their use according to international guidelines. New agents are under development.

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“…HIV/AIDS and dementia, diagnoses included within the CCI, were consistently the least occurring comorbidities across the cohorts. Although HIV/AIDS have been documented as a significant comorbidity in immunocompromised patients and liver failure patients, 30 , 31 they may be underrepresented in the Optum commercial dataset. Finally, CCI cohort demonstrated higher comorbidity burdens for patients developing invasive mold infections, indicating higher mortality and/or higher resource use at the outset.…”

Section: Discussionmentioning

confidence: 99%

Patient Characteristics and Risk Factors in Invasive Mold Infections: Comparison from a Systematic Review and Database Analysis

Sung

Martin

Phan

et al. 2021

CEOR

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Introduction Diagnosis and treatment of invasive mold infections (IMI) can be challenging and IMI is a significant source of morbidity and mortality. Invasive aspergillosis (IA) and invasive mucormycosis (IM) are two of the most common mold infections. A better understanding of patient comorbidities and risk factors that predispose IMI may help clinicians to refine the difficult diagnostic and treatment process. Methods A systematic literature review (SLR) was conducted (January 2008–October 2019) for studies reporting comorbidities/risk factors of patients with IA or IM (Phase I), followed by an analysis on the Optum ® US EHR database of prominent risk factor cohorts based on SLR findings and expert opinion (Phase II). From the four identified patient cohorts: 1) patients undergoing solid organ transplant (SOT) and patients with 2) hematologic cancers, 3) diabetes, or 4) lung disease, rates of IA, IM, or concurrent IA and IM; patient comorbidities; and Charlson Comorbidity Index (CCI) scores were reported. Results The SLR included 88 studies, and 46 were used to select comorbidities/risk factors cohorts in IA and IM patients. The most important comorbidities/risk factors in IA and IM patients were diabetes, lung disease, hematological malignances, and SOT. In the Optum database (N=101,340,454 patients), IA rates were highest in lung transplant (10.81%) patients and IM rates were highest in intestine transplant (0.83%) patients, lung transplant (0.43%), and hematopoietic stem cell transplant (0.49%). CCI scores were elevated in all mold infection groups compared to the total Optum cohort. Conclusion The current study describes patient comorbidity and risk factors associated with IA and IM. These data can be used to refine clinical decision-making regarding when to suspect mold infections. Future research should focus on identifying whether patients respond differently to various antifungal treatments to determine if strategic recommendations should be made for certain patient groups.

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Epidemiology of invasive pulmonary aspergillosis in patients with liver failure: Clinical presentation, risk factors, and outcomes

Cited by 21 publications

References 27 publications

Invasive Pulmonary Aspergillosis in Nonimmunocompromised Hosts

Invasive Pulmonary Aspergillosis in Nonimmunocompromised Hosts

Invasive Pulmonary Aspergillosis

Patient Characteristics and Risk Factors in Invasive Mold Infections: Comparison from a Systematic Review and Database Analysis

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