疑似侵袭性肺曲霉病血液病患者支气管肺泡灌洗液铁水平及其与12周死亡率的关系：一项回顾性队列研究

IF 3.6 3区生物学 Q2 MYCOLOGY

Mycopathologia Pub Date : 2025-02-03 DOI:10.1007/s11046-025-00934-w

H Lamberink, J Heijmans, A Wagemakers, K van Dijk

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引用次数: 0

摘要

目的：使用支气管肺泡灌洗液（BALF）诊断侵袭性肺曲霉病（IPA）的准确性仍然不理想。肺移植和小鼠模型中组织铁的升高与侵袭性曲霉生长有关。本研究探讨了半胱氨酸铁水平、IPA和12周死亡率之间的相关性。方法：我们在一家三级保健中心进行了一项回顾性队列研究，包括2014年至2019年间来自血液恶性肿瘤和疑似IPA患者的100例BALF样本。分析有关铁浓度、真菌学试验和12周死亡率的数据。结果：根据EORTC/MSGERC 2020的定义，铁水平越高，IPA的可能性越大（p = 0.038）。ROC面积为0.648 (95% CI 0.531-0.764)，最佳临界值为0.75µmol/L，以区分病例（27例可能IPA， 0例证实IPA）和对照组（56例可能IPA， 17例无IPA），灵敏度为76.9%，特异性为47.3%。铁水平与较高的真菌负荷呈正相关(半乳甘露聚糖：Spearman ρ 0.323, p = 0.001；曲霉PCR ct值：ρ - 0.602, p = 0.002)。铁浓度≥0.90µmol/L的患者12周死亡率高于铁浓度较低的患者（p = 0.086）。结论：可能患有IPA的患者BALF铁浓度最高，其次是可能患有IPA的患者，无IPA的患者BALF铁浓度最低，较高的铁水平也与真菌负荷相关，并可能与12周死亡率相关。然而，考虑到各种潜在的混杂因素，进一步的前瞻性研究对于确定因果关系至关重要。这些发现值得进一步研究BALF铁作为12周生存期的潜在标志物，但在考虑将其作为当前EORTC/MSGERC 2020分类中可能或可能的IPA的补充标志物之前，需要进行验证。

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Iron Levels in Bronchoalveolar Lavage Fluid of Hematological Patients with Suspected Invasive Pulmonary Aspergillosis and their Association with 12-week Mortality: A Retrospective Cohort Study.

Objectives: Accuracy of diagnostic tests for invasive pulmonary aspergillosis (IPA) using bronchoalveolar lavage fluid (BALF) remains suboptimal. Elevated tissue iron in lung transplant and murine models is linked to invasive Aspergillus growth. This study examines the correlation between BALF iron levels, IPA, and 12-week mortality.

Methods: We conducted a retrospective cohort study at a tertiary care center, including 100 BALF samples from patients with hematological malignancies and suspected IPA between 2014 and 2019. Data regarding iron concentrations, mycological tests, and 12-week mortality were analyzed.

Results: Higher iron levels correlated with a greater likelihood of IPA based on EORTC/MSGERC 2020 definitions (p = 0.038). The ROC area was 0.648 (95% CI 0.531-0.764), with an optimal cut-off of 0.75 µmol/L to distinguish cases (27 probable and 0 proven IPA) from controls (56 possible and 17 no IPA), with sensitivity 76.9% and specificity 47.3%. Iron levels were positively correlated with higher fungal loads (galactomannan: Spearman's ρ 0.323, p = 0.001; Aspergillus PCR Ct-values: ρ - 0.602, p = 0.002). A trend toward higher 12-week mortality was observed in patients with iron concentrations ≥ 0.90 µmol/L compared to lower levels (p = 0.086).

Conclusions: BALF iron concentrations were highest in those with probable IPA, followed by possible IPA and lowest in patients without IPA, with higher iron levels also correlating with fungal loads and potentially with 12-week mortality. However, given the various potential confounding factors, further prospective studies are essential to establish causality. These findings warrant additional investigation into BALF iron as a potential marker for 12-week survival, but validation is necessary before considering it as a supplementary marker in the current EORTC/MSGERC 2020 classification for probable or possible IPA.

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来源期刊

Mycopathologia 生物-真菌学

CiteScore

6.80

自引率

3.60%

发文量

审稿时长

3 months

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.