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Clinical Features and Co-Infections in Invasive Pulmonary Aspergillosis in Elderly Patients
Minxi Lao1, Kaicong Zhang1, Meng Zhang2
1Department of Geriatrics, The First Affiliated Hospital of Sun Yat-sen University, Guangzhou, People's Republic of China.
Introduction:
Invasive pulmonary aspergillosis (IPA) is a potentially lethal opportunistic infection. Old age is one of the important risk factors of IPA. However, data regarding the clinical characteristics and prognostic factors of elderly patients with IPA are limited, with data regarding co-infection of other bacteria or fungi even scarcer.
Methods:
We performed a retrospective study of elderly patients (aged≥60) with IPA diagnosed in the First Affiliated Hospital of Sun Yat-sen University from January 2000 to December 2019. Data collection included demographic characteristics, premorbid conditions, underlying diseases, clinical manifestations, therapeutic procedures, and pathogenic detection. Associated factors were analyzed by logistic regression analysis.
Results:
A total of 97 elderly patients (75 males, 22 females) with IPA were included. The all-cause mortality rate was 36.1% (35/97). Body mass index (BMI) (adjusted odds ratio (OR) 1.27, 95% confidence interval (CI) 1.08-1.50, P=0.01), solid organ malignancy (adjusted OR 5.37, 95% CI 1.35-21.33, P=0.02), and co-infections (adjusted OR 5.73, 95% CI 1.40-23.51, P=0.02) were associated with mortality in the elderly patients with IPA. Nearly, 76.3% (74/97) of the patients developed co-infections. Most of the infections (55/74, 74.3%) involved the lung. A total of 77 strains of bacteria were isolated, and Gram-negative bacteria (63/77, 81.3%) were predominant. Patients with co-infections are older (72.3±7.6 vs 67.4±7.4, P=0.04), prone to admit to the intensive care unit (ICU) (59.5% vs 26.1%, P=0.01), and present lymphopenia (60.8% vs 26.1%, P=0.004). In multivariate analysis, ICU admission (adjusted OR 4.57, 95% CI 1.53-13.67, P=0.01), and lymphopenia (adjusted OR 4.82, 95% CI 1.62-14.38, P=0.01) were significantly associated with co-infection in the elderly patients with IPA.
Conclusion:
IPA is a fatal disease in the elderly population. Co-infection is closely associated with mortality. Lymphopenia could be an indicator for co-infection in the elderly patients with IPA.
Insights
Invasive pulmonary aspergillosis (IPA) is a deadly infection in older adults, with co-infections significantly increasing mortality risk. Lymphopenia may indicate co-infection in elderly IPA patients.
Area of Science:
- Infectious Diseases
- Pulmonology
- Geriatrics
Background:
- Invasive pulmonary aspergillosis (IPA) is a life-threatening opportunistic infection, particularly in the elderly.
- Risk factors and clinical characteristics of IPA in older adults are not well-documented, especially concerning co-infections.
Purpose of the Study:
- To investigate the clinical features and prognostic factors of IPA in elderly patients.
- To identify factors associated with mortality and co-infections in this demographic.
Main Methods:
- Retrospective study of 97 elderly patients (≥60 years) with IPA diagnosed between 2000-2019.
- Data included demographics, comorbidities, clinical presentation, treatment, and pathogen detection.
- Logistic regression analysis was used to identify associated factors.
Main Results:
- All-cause mortality rate was 36.1%.
- Factors associated with mortality included higher BMI, solid organ malignancy, and co-infections.
- Co-infections, predominantly Gram-negative bacterial, occurred in 76.3% of patients.
- Co-infected patients were older, more likely to be admitted to the ICU, and presented with lymphopenia.
- ICU admission and lymphopenia were significantly associated with co-infection.
Conclusions:
- IPA poses a significant mortality risk in the elderly population.
- Co-infection is a critical factor linked to increased mortality in elderly IPA patients.
- Lymphopenia may serve as an early indicator of co-infection in elderly patients with IPA.
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