In-Hospital Mortality Among Hematological Malignancy Patients Undergoing Bronchoscopy for Suspected Invasive Pulmonary Aspergillosis: Focusing on Coinfections and Nodules on Chest CT.
N A Acet-Öztürk, D Ömer-Topçu, K V Acar, Ö Aydın-Güçlü, I E Pınar, E Demirdöğen, A Görek-Dilektaşlı, E Kazak, V Özkocaman, A Ursavas, F Özkalemkaş, B Ener, R Ali, H Akalın
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Abstract
Introduction: Invasive pulmonary aspergillosis (IPA) in hematological malignancy populations has high mortality rates. While there are identified prognostic factors for mortality, conflicting results are reported from the studies including bronchoalveolar lavage galactomannan (GM) measurements and co-infections. We aimed to evaluate risk factors associated with in-hospital mortality in a hematological malignancy population undergoing bronchoscopy with a preliminary diagnosis of IPA in a single tertiary care center.
Method: Patients undergoing bronchoscopy with a preliminary diagnosis of IPA were included in this retrospective study. Bacterial co-infection was defined as a positive bacterial culture in respiratory samples within ± 7 days of the index bronchoscopy procedure.
Results: Study population consisted 305 patients diagnosed as possible, probable or proven IPA. 57 patients presented with fungal and bacterial co-infection. In-hospital mortality was observed in 98 (33.6%) patients. Patients with mortality status were older and were not in remission for hematological malignancy. Serum GM, bronchoalveolar lavage (BAL) GM and bronchial lavage (BL) GM levels showed a significant relation with in-hospital mortality but weak accuracy. In multivariate analysis for risk factors of in-hospital mortality; age, remission status, number of nodules in HRCT and having fungal infections with or without combined bacterial infection were independent risk factors.
Conclusion: Co-infections in this susceptible population should not be overlooked even in the presence of fungal infection evidence. BAL and BL GM tended to have a stronger relation with survival than serum GM measurements taken at the same time. The number of nodules in radiological assessment might be an indicator of mortality. Radiological changes through the disease course might be assessed in further studies.
期刊介绍：
Mycopathologia is an official journal of the International Union of Microbiological Societies (IUMS). Mycopathologia was founded in 1938 with the mission to ‘diffuse the understanding of fungal diseases in man and animals among mycologists’. Many of the milestones discoveries in the field of medical mycology have been communicated through the pages of this journal. Mycopathologia covers a diverse, interdisciplinary range of topics that is unique in breadth and depth. The journal publishes peer-reviewed, original articles highlighting important developments concerning medically important fungi and fungal diseases. The journal highlights important developments in fungal systematics and taxonomy, laboratory diagnosis of fungal infections, antifungal drugs, clinical presentation and treatment, and epidemiology of fungal diseases globally. Timely opinion articles, mini-reviews, and other communications are usually invited at the discretion of the editorial board. Unique case reports highlighting unprecedented progress in the diagnosis and treatment of fungal infections, are published in every issue of the journal. MycopathologiaIMAGE is another regular feature for a brief clinical report of potential interest to a mixed audience of physicians and laboratory scientists. MycopathologiaGENOME is designed for the rapid publication of new genomes of human and animal pathogenic fungi using a checklist-based, standardized format.
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