Invasive Pulmonary Aspergillosis in Patients with Acute-on-chronic Liver Failure

Wu, Zijian; Ling, Zongxin; Shao, Feng; Sheng, Jifang; Li, L

doi:10.1177/030006051204000537

Cited by 18 publications

(28 citation statements)

References 31 publications

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“…Vor: Voriconazole). Author (year) Ref liver diseases ACLF criteria IPA criteria IPA Incidence Transplant-free Mortality Anti-fungal treatments Cas/Vor/others Wang, 2010 11 HBV ACLF CSID/CSH EORTC/MSG 66/798 (8.3%) 100% (30 days) C43/V0/0 Wu, 2012 10 HBV ACLF APASL EORTC/MSG 29/470 (6.1%) 86.2% (in hospital) C0/V29/0 Chen, 2013 9 HBV ACLF APASL EORTC/MSG 39/787 (5%) 94.8% (90 days) C10/V9/20 others Gustot, 2014 6 Alcoholic hepatitis — EORTC/MSG 13/94 (13.8%) 100% (40 days) C6/V2/6 others Falcone, 2011 5 Critical liver disorders — EORTC/MSG — 48/67 (71.6%) C13/V5/30 others Zhao, 2011 28 HBV ACLF CSID/CSH CSCC 2007 83/681 (12.1%) 73.49% (in hospital) C0/V0/others Zou, 2012 29 HBV ACLF CSID/CSH EORTC/MSG 39/967 (4%) 79.5% (30 days) C6/V0/others Liu, 2013 30 HBV ACLF CSID/CSH EORTC/MSG 20/463 (4.3%) 75% (in hospital) C0/V5/others …”

Section: Discussionmentioning

confidence: 99%

“…The prevalence of IPA in HBV-related ACLF patients has been reported to be 5.0–8.3% 9 – 11 , reaching 13.8% (13/94) in patients with severe alcoholic hepatitis 6 . The short-term mortality observed in these patients ranged from 73.5% to 100% 6 , 9 , 10 . However, currently no criteria are available to identify patients with poor prognosis.…”

Section: Introductionmentioning

confidence: 89%

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Improving survival of acute-on-chronic liver failure patients complicated with invasive pulmonary aspergillosis

Gao

Zhang

et al. 2018

Sci Rep

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The mortality of acute-on-chronic liver failure (ACLF) patients complicated with invasive pulmonary aspergillosis (IPA) was extremely high. We aimed to explore prognostic value of the Chronic Liver Failure-Sequential Organ Failure Assessment (CLIF-SOFA) lung score and to establish an optimal voriconazole regimen for ACLF patients complicated with IPA. We retrospectively screened hospitalized ACLF patients in our hospital from July 2011 to April 2016, from which 20 probable IPA cases were diagnosed. Along with onsets of IPA, deteriorated diseases severity, especially lung conditions were found in those 20 ACLF patients. It was found that IPA patients with CLIF-SOFA lung score <2 had better 28-day survival than those with lung score >1 (11/13 vs 0/7, p < 0.001). Based on plasma voriconazole concentration measurement, an optimal voriconazole regimen (loading doses: 0.2 g twice daily; maintenance doses, 0.1 g once daily) was established, which resulted in rational trough plasma drug concentrations (1–5 μg/mL), good clinical outcomes (90-day survival rate of 6/8) and no observed adverse events. In conclusion, CLIF-SOFA lung score >1 was able to identify ACLF patients complicated with IPA encountering much higher 28-day mortality. An optimal voriconazole regimen was safe and effective in our ACLF patients complicated with IPA.

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Section: Discussionmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 89%

Improving survival of acute-on-chronic liver failure patients complicated with invasive pulmonary aspergillosis

Gao

Zhang

et al. 2018

Sci Rep

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“…The incidence of IFI among patients with advanced liver disease has been reported to be as high as 10% [23,24], with a mortality rate up to 98% [2,5,[25][26][27]. In addition, liver disease has been found to be an independent risk factor for mortality [25], possibly because of abnormalities of the immune system [6,[28][29][30].…”

Section: Discussionmentioning

confidence: 99%

Comparison of the Safety and Tolerance Profile of Micafungin with that of Other Echinocandins and Azoles in Patients with Pre-existing Child–Pugh B or C Liver Disease: A Case–Control Retrospective Study

et al. 2020

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Introduction: To assess the association between exposure to micafungin, other echinocandins, or azoles and the development of short-term liver injury (STLI) or long-term liver injury (LTLI) in patients with Child-Pugh B or C liver disease. Methods: Multicenter case-control study of patients with Child-Pugh B or C liver disease who received antifungals (AF) for C 72 h (May 2009-May 2015) in six Spanish and Italian hospitals. All micafungin patients were randomly matched with one patient who received another echinocandin and with one patient who received azole treatment. Primary outcome was development of STLI or LTLI (development of any type of liver tumor during the follow-up period). Results: Of 2335 patients with chronic liver disease admitted to the six centers, 20 (0.85%) were found to have Child-Pugh B or C liver disease and received micafungin for C 72 h. During AF treatment, the frequency of STLI was 10% in each group. Most cases of STLI were asymptomatic, and AFs had to be switched to another class of AF in only two patients (one micafungin and one azole). No patients developed acute liver insufficiency, were admitted to the ICU, or had to undergo transplantation. Follow-up data (median of 1.3 years) were Enhanced digital features To view enhanced digital features for this article go to https://doi.org/10.6084/ m9.figshare.11550816.

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“… 2 – 5 Although patients with liver failure have a low incidence of invasive aspergillosis, recent data have indicated that this condition should be reconsidered as a devastating infectious disease in this population. 3 – 5 Wu et al. 5 showed that most patients with acute-on-chronic liver failure (ACLF) died within 7 days after the onset of IPA (25/29 patients).…”

Section: Introductionmentioning

confidence: 99%

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

Zhang

Yang

et al. 2017

J Int Med Res

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ObjectiveInvasive pulmonary aspergillosis (IPA) is a severe and often lethal infection. The possible risk factors, clinical presentation, and treatment of patients with simultaneous liver failure and IPA have received little attention in previous studies. The aim of this study was to investigate the epidemiology of IPA in patients with liver failure in an effort to reduce patient mortality.MethodsThe patients with liver failure (including acute liver failure , sub-acute liver failure , acute-on-chronic liver failure and chronic liver failure) were recruited from 2011 to 2016. The clinical data of these patients were retrieved for the study.ResultsIn total, 1077 patients with liver failure were included in this study. Of the 1077 patients, 53 (4.9%) had IPA. Forty-four (83%) patients with IPA died. Independent risk factors for IPA were male sex (hazard ratio [HR] = 2.542), hepatorenal syndrome (HR = 2.463), antibiotic use (HR = 4.631), and steroid exposure (HR = 18.615).ConclusionsIPA is a fatal complication in patients with liver failure. Male sex, hepatorenal syndrome, antibiotic use, and steroid exposure were independent risk factors for IPA. When patients with liver failure have these risk factors and symptoms of pneumonia such as cough or hemoptysis, clinicians should be cautious about the possibility of IPA.

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Invasive Pulmonary Aspergillosis in Patients with Acute-on-chronic Liver Failure

Cited by 18 publications

References 31 publications

Improving survival of acute-on-chronic liver failure patients complicated with invasive pulmonary aspergillosis

Improving survival of acute-on-chronic liver failure patients complicated with invasive pulmonary aspergillosis

Comparison of the Safety and Tolerance Profile of Micafungin with that of Other Echinocandins and Azoles in Patients with Pre-existing Child–Pugh B or C Liver Disease: A Case–Control Retrospective Study

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

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