Clinical features of invasive pulmonary aspergillosis vs. colonization in COPD patients distributed by gold stage
Jose Barberan1, Francisco Sanz, Jose-Luis Hernandez
1Infectious Diseases Dpt., Hospital Central de la Defensa Gomez Ulla, Gta. del Ejército s/n, 28047 Madrid, Spain. josebarberan@teleline.es
Objective:
To explore clinical features of invasive pulmonary aspergillosis (IPA) vs. colonization among hospitalized COPD patients.
Methods:
Records of COPD patients with two respiratory cultures yielding Aspergillus were retrospectively reviewed. Cases categorized as proven/probable IPA or colonization was analyzed.
Results:
118 patients were identified: 70 (59.3%) colonized, 48 (40.7%) with IPA (42 probable, 6 proven). Higher percentage of IPA patients (vs. colonized) presented GOLD III + IV (77.1% vs. 57.1%, p = 0.025). IPA patients presented higher Charlson index (3.5 ± 2.5 vs. 2.6 ± 2.2, p = 0.027), higher rate of ICU admission (27.1% vs. 4.3%, p = 0.001) and worse prognosis (McCabe rapidly fatal category: 31.3% vs. 7.1%, p = 0.001). GOLD-I IPA patients presented risk factors other than COPD. Before hospitalization, 66.7% IPA and 28.6% colonized patients were taking steroids (p < 0.001). Antifungals were administered to 83.3% IPA and 21.4% colonized patients (p < 0.001). Mortality was higher among IPA vs. colonized patients, both in global (58.3% vs. 10.0%, p < 0.001), GOLD-I (75.0% vs. 10.0%, p = 0.041), GOLD-II (42.9% vs. 5.0%, p = 0.042) and GOLD-III patients (54.2% vs. 0.0%, p < 0.001), but not in GOLD-IV patients (69.2% vs. 31.3%, p = 0.066).
Conclusions:
IPA should be suspected not only in GOLD-III and GOLD-IV COPD patients, with higher mortality in IPA vs. colonized patients for GOLD-II and -III COPD patients.
Insights
Invasive pulmonary aspergillosis (IPA) is more common in severe COPD patients and linked to higher mortality. Early suspicion and treatment are crucial for better outcomes in these patients.
Area of Science:
- Pulmonology
- Infectious Diseases
- Critical Care Medicine
Background:
- Chronic Obstructive Pulmonary Disease (COPD) is a progressive lung disease.
- COPD patients are at increased risk for respiratory infections, including fungal infections.
- Distinguishing invasive pulmonary aspergillosis (IPA) from Aspergillus colonization is clinically important in COPD patients.
Purpose of the Study:
- To compare the clinical features of invasive pulmonary aspergillosis (IPA) versus Aspergillus colonization in hospitalized patients with COPD.
- To identify risk factors and outcomes associated with IPA in COPD.
Main Methods:
- Retrospective review of medical records of hospitalized COPD patients with two positive Aspergillus respiratory cultures.
- Categorization of cases into proven/probable IPA or colonization.
- Analysis of clinical characteristics, treatment, and outcomes.
Main Results:
- Of 118 patients, 48 (40.7%) had IPA and 70 (59.3%) had colonization.
- IPA patients more frequently had GOLD stages III-IV COPD, higher Charlson index, and increased ICU admissions.
- Mortality was significantly higher in IPA patients across most GOLD stages compared to colonized patients.
Conclusions:
- Invasive pulmonary aspergillosis should be suspected in COPD patients, particularly those with GOLD stages III and IV.
- Higher mortality rates in IPA patients compared to colonized patients underscore the need for timely diagnosis and management.
