Background
Increasing cases of pulmonary aspergillosis (IPA) in immunocompetent patients with severe influenza have been reported. Howevere, the risk factors for occurence and death are largely unknown.
Methods
Data of hospitalised patients with influenza A-related pneumonia (FluA-p) obtained from five teaching hospitals from 2031 to 2018, were reviewed. Univariate and multivariate logistical regression analyses were performed to determine the risk factors involved in the acquisition and 60-day mortality in IPA patients.
Results
Of the 693 FluA-p patients included in the study, 3.0% (21/693) were IPA patients with a 60-day mortality of 42.9% (9/21). Adjusted for confounders, a Cox proportional hazard model showed that IPA was associated with increased risk for 60-day mortality [hazard ratio ( HR) 4.336, 95% confidence interval (CI) 1.191-15.784, p = 0.026] in FluA-p patients. A multivariate logistic regression model confirmed that age (odd ratio ( OR) 1.147, 95% CI 1.048-1.225, p = 0.003), systemic corticosteroids use before IPA diagnosis ( OR 33.773, 95% CI 5.681-76.764, p < 0.001), leukocytes > 10×10 9 /L ( OR 1.988, 95% CI 1.028-6.454, p = 0.029) and lymphocytes < 0.8×10 9 /L on admission ( OR 34.813, 95% CI 1.676-73.006, p = 0.022), were related with the acquisition of IPA. Early neuraminidase inhibitor use ( OR 0.290, 95% CI 0.002-0.584, p = 0.021) was associated with a decreased risk for a 60-day mortality in IPA patients.
Conclusions
Our results showed that IPA worsen the clinical outcomes of FluA-p patients. The risk factors for the acquisition and death were helpful for the clinicians in preventing and treating IPA.
Figure 1
Figure 2
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Posted 10 Apr, 2020
On 09 Sep, 2020
On 09 Sep, 2020
Received 26 Apr, 2020
Received 26 Apr, 2020
On 25 Apr, 2020
On 22 Apr, 2020
Invitations sent on 21 Apr, 2020
On 15 Apr, 2020
On 08 Apr, 2020
On 08 Apr, 2020
On 02 Apr, 2020
Posted 10 Apr, 2020
On 09 Sep, 2020
On 09 Sep, 2020
Received 26 Apr, 2020
Received 26 Apr, 2020
On 25 Apr, 2020
On 22 Apr, 2020
Invitations sent on 21 Apr, 2020
On 15 Apr, 2020
On 08 Apr, 2020
On 08 Apr, 2020
On 02 Apr, 2020
Background
Increasing cases of pulmonary aspergillosis (IPA) in immunocompetent patients with severe influenza have been reported. Howevere, the risk factors for occurence and death are largely unknown.
Methods
Data of hospitalised patients with influenza A-related pneumonia (FluA-p) obtained from five teaching hospitals from 2031 to 2018, were reviewed. Univariate and multivariate logistical regression analyses were performed to determine the risk factors involved in the acquisition and 60-day mortality in IPA patients.
Results
Of the 693 FluA-p patients included in the study, 3.0% (21/693) were IPA patients with a 60-day mortality of 42.9% (9/21). Adjusted for confounders, a Cox proportional hazard model showed that IPA was associated with increased risk for 60-day mortality [hazard ratio ( HR) 4.336, 95% confidence interval (CI) 1.191-15.784, p = 0.026] in FluA-p patients. A multivariate logistic regression model confirmed that age (odd ratio ( OR) 1.147, 95% CI 1.048-1.225, p = 0.003), systemic corticosteroids use before IPA diagnosis ( OR 33.773, 95% CI 5.681-76.764, p < 0.001), leukocytes > 10×10 9 /L ( OR 1.988, 95% CI 1.028-6.454, p = 0.029) and lymphocytes < 0.8×10 9 /L on admission ( OR 34.813, 95% CI 1.676-73.006, p = 0.022), were related with the acquisition of IPA. Early neuraminidase inhibitor use ( OR 0.290, 95% CI 0.002-0.584, p = 0.021) was associated with a decreased risk for a 60-day mortality in IPA patients.
Conclusions
Our results showed that IPA worsen the clinical outcomes of FluA-p patients. The risk factors for the acquisition and death were helpful for the clinicians in preventing and treating IPA.
Figure 1
Figure 2
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