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- Title
Risk factors for short-term prognosis of end-stage liver disease complicated by invasive pulmonary aspergillosis.
- Authors
Yu, Weiyan; Xiao, Ying; Luo, Yue; Hu, Yangyang; Ji, Ru; Wang, Wei; Wu, Zhinian; Qi, Zeqiang; Guo, Tingyu; Wang, Yadong; Zhao, Caiyan
- Abstract
Background and aim: Patients with end-stage liver disease (ESLD) are susceptible to invasive pulmonary aspergillosis (IPA). This study aimed to investigate the risk factors affecting the occurrence and short-term prognosis of ESLD complicated by IPA. Methods: This retrospective case–control study included 110 patients with ESLD. Of them, 27 ESLD-IPA received antifungal therapy with amphotericin B (AmB); 27 AmB-free-treated ESLD-IPA patients were enrolled through 1:1 propensity score matching. Fifty-six ESLD patients with other comorbid pulmonary infections were enrolled as controls. The basic features of groups were compared, while the possible risk factors affecting the occurrence and short-term outcomes of IPA were analyzed. Results: Data analysis revealed invasive procedures, glucocorticoid exposure, and broad-spectrum antibiotic use were independent risk factors for IPA. The 54 patients with ESLD-IPA exhibited an overall treatment effectiveness and 28-d mortality rate of 50.00% and 20.37%, respectively, in whom patients treated with AmB-containing showed higher treatment efficacy than patients treated with AmB-free antifungal regimens (66.7% vs. 33.3%, respectively, χ2 = 6.000, P = 0.014). Multivariate logistic regression analysis revealed that the treatment regimen was the only predictor affecting patient outcomes, with AmB-containing regimens were 4.893 times more effective than AmB-free regimens (95% CI, 1.367–17.515; P = 0.015). The only independent predictors affecting the 28-d mortality rate were neutrophil-to-lymphocyte ratio and IPA diagnosis (OR = 1.140 and 10.037, P = 0.046 and 0.025, respectively). Conclusions: Glucocorticoid exposure, invasive procedures, and broad-spectrum antibiotic exposure increased the risk of IPA in ESLD patients. AmB alone or combined with other antifungals may serve as an economical, safe, and effective treatment option for ESLD-IPA.
- Subjects
PULMONARY aspergillosis; ASPERGILLOSIS; LIVER diseases; PROPENSITY score matching; AMPHOTERICIN B; LOGISTIC regression analysis; NEUTROPHIL lymphocyte ratio; ANTIFUNGAL agents
- Publication
European Journal of Clinical Microbiology & Infectious Diseases, 2024, Vol 43, Issue 4, p713
- ISSN
0934-9723
- Publication type
Article
- DOI
10.1007/s10096-024-04775-1