Prognostic factors for invasive aspergillosis in patients with haematological malignancies

Reliable data defining risk factors for invasive aspergillosis (IA) in haematological patients are limited. Analysis of factors influencing IA-associated death is especially valuable in the light of recent progress in managing IA. Between 1997 and 2005 we evaluated factors influencing IA-attributable mortality. For univariate analyses we used Wilcoxon and log-rank test, and for multivariate analysis a Cox model of logistic backward regression was applied. Attributable mortality was 41% after 1 y. 50% of attributable deaths occurred within 6 weeks after IA diagnosis. Various parameters significantly correlated with death after IA: 1) uncontrolled malignancy (p =0.007); 2) extrapulmonary disease (p =0.0003); 3) stable disease, mixed response or progressive disease at first radiological evaluation (p =0.004); 4) proven IA (p =0.02); 5) IA > 110 d after PBSCT (p =0.0112). Prolonged duration of neutropenia was associated with increased mortality (p =0.0001). We observed a trend towards improved survival of IA during recent y (2003-2005). In a multivariate analysis, factors independently associated with attributable mortality included y of first diagnosis (p =0.0492), extrapulmonary IA (p =0.0353) and duration of neutropenia (p =0.0088). In conclusion, the identified risk factors may serve for the definition of high-risk situations. In these settings, increased efforts of prevention, early diagnosis and aggressive treatment of IA are warranted in order to improve survival.