Predictive factors for treatment response and mortality in chronic pulmonary aspergillosis

Abstract

ObjectivesChronic pulmonary aspergillosis (CPA) is associated with significant mortality, and suboptimal antifungal treatment response. We describe predictive factors for treatment response and survival.MethodsWe retrospectively analysed clinical, serological and radiological parameters at baseline and following antifungal treatment in patients with CPA and correlated with clinical and radiological response and survival.ResultsFifty‐nine patients were included with a mean age of 61 years. Thirty (51%) had a diagnosis of COPD. On clinical assessment at 6 months, 21 (36%) had clinically improved, 20 (34%) were clinically stable and 15 (25%) had deteriorated. Radiological improvement was observed in 30 (53%), stability in 11 (19%) and deterioration in 16 (28%). Only a lower C‐reactive protein (CRP) at baseline was associated with a favourable clinical‐radiological response. On univariate analysis, lower CRP, higher albumin, lower Aspergillus IgG and use of inhaled steroids were associated with lower mortality. An overall favourable response at 6 months was associated with lower mortality.ConclusionInflammatory markers and Aspergillus IgG were predictors of mortality in CPA. This suggests that mortality in CPA is driven mainly by the chronic fungal infection itself rather than the underlying disease, therefore early optimised treatment of CPA may lead to improved outcomes.

Management of Polypharmacy and Potential Drug–Drug Interactions in Patients with Pulmonary Aspergillosis: A 2-Year Study of a Multidisciplinary Outpatient Clinic

“…The use of these drugs in the context of pulmonary aspergillosis is a matter of debate for the need to balance the potential beneficial and harmful effects. Indeed, Kosmidis et al recently reported that inhaled steroids in patients with chronic pulmonary aspergillosis were associated with lower mortality mainly due to a reduction in inflammation [30]. On the other hand, extensive evidence is also available showing that the isolation and colonization of Aspergillus spp.…”

Chronic pulmonary aspergillosis: comprehensive insights into epidemiology, treatment, and unresolved challenges

“…The 1-year mortality rate in CPA patients ranges from 7% to 32% and increases to a substantial 38–52.6% at 5 years, indicating a poor prognosis. 105 , 355 – 359 Factors contributing to mortality in CPA can be broadly categorized into patient-specific characteristics, comorbidities, and various laboratory parameters. Patient-specific characteristics associated with CPA-related mortality include age 65 years or older, male sex, underweight (BMI < 18.5 kg/m 2 ), worsening St George’s Respiratory Questionnaire activity domain scores, and malnutrition.…”

“… 92 , 93 , 97 , 357 , 358 , 360 , 362 – 364 Laboratory parameters associated with CPA-related mortality include low serum albumin, elevated CRP, high TNF-α, high IL-1β, elevated Aspergillus IgG, and the presence of an aspergilloma. 356 , 357 , 359 , 362 , 363 , 365 Of note among specific patient backgrounds is the impact of impaired IFN-γ production, which has been reported to negatively influence CPA prognosis. 114 Conversely, factors predictive of favorable outcomes include higher BMI, lower Charlson Comorbidity Index, and antifungal therapy for more than 6 months.…”