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Clinical Characteristics, Prognosis, and Risk Factors for Mortality in Influenza-Associated Pulmonary Aspergillosis
Qiuting Jiang1,2, Liang Xu2,3, Wei Zhou2,4
1Department of Respiratory and Critical Care Medicine, Linping Hospital of Integrated Traditional Chinese and Western Medicine, Hangzhou, 311100, People's Republic of China.
Objective:
Multiple studies have confirmed that viral pneumonia is a high-risk factor for invasive pulmonary aspergillosis (IPA), this retrospective study aims to analyze the differences in clinical characteristics, prognosis, and high-risk factors for mortality between patients with influenza virus-associated pulmonary aspergillosis (IAPA) and those with COVID-19-associated pulmonary aspergillosis (CAPA).
Methods:
Clinical data from IAPA and CAPA patients diagnosed at four hospitals were collected. The clinical characteristics and prognostic differences between the two groups were analyzed and compared, with Cox regression used to identify the risk factors for mortality.
Results:
A total of 106 patients were included in this study. Compared to CAPA patients, IAPA patients had a higher proportion of chronic obstructive pulmonary disease comorbidities, lower rates of history of solid organ transplantation, and a shorter time from viral infection to aspergillosis development. CAPA patients exhibited lower levels of white blood cells, and C-reactive protein. The CAPA group also received longer courses of antibiotic and corticosteroid therapy. Compared to IAPA, the CAPA group exhibited a higher incidence of complications, including bacterial infections, deep vein thrombosis in the lower limbs, gastrointestinal bleeding, and heart failure. The mortality rate was also higher in the CAPA group. The survival curve of IAPA was more favorable than that of CAPA. Cox regression analysis identified ICU admission at diagnosis as an independent risk factor for mortality in IAPA patients (OR= 9.578).
Conclusion:
The IAPA group had a higher proportion of patients with COPD, a more acute disease onset, Admission to the ICU at diagnosis was identified as a risk factor for IAPA-related mortality. In comparison, the CAPA group had a higher proportion of immunodeficient patients, received more corticosteroid treatment, and was more susceptible to complications such as bacterial infections, thrombosis, and gastrointestinal bleeding, all of which contributed to an increased risk of death.
Insights
Influenza virus-associated pulmonary aspergillosis (IAPA) patients had better outcomes than COVID-19-associated pulmonary aspergillosis (CAPA) patients. ICU admission was a risk factor for IAPA mortality, while CAPA patients faced more complications and higher death rates.
Area of Science:
- Pulmonology
- Infectious Diseases
- Critical Care Medicine
Background:
- Viral pneumonia is a significant risk factor for invasive pulmonary aspergillosis (IPA).
- Distinguishing between influenza virus-associated pulmonary aspergillosis (IAPA) and COVID-19-associated pulmonary aspergillosis (CAPA) is crucial for patient management.
Purpose of the Study:
- To compare the clinical characteristics, prognosis, and mortality risk factors of IAPA versus CAPA.
- To identify key differences in patient populations and treatment outcomes between IAPA and CAPA.
Main Methods:
- Retrospective analysis of clinical data from 106 patients diagnosed with IAPA or CAPA across four hospitals.
- Comparative analysis of clinical features and prognostic indicators.
- Cox regression modeling to determine independent risk factors for mortality.
Main Results:
- IAPA patients more frequently had COPD and a shorter time from viral infection to aspergillosis onset.
- CAPA patients showed lower white blood cell and C-reactive protein levels, received longer antibiotic/corticosteroid therapy, and experienced more complications (bacterial infections, thrombosis, bleeding, heart failure).
- CAPA group had a higher mortality rate and less favorable survival curve; ICU admission was an independent risk factor for IAPA mortality.
Conclusions:
- IAPA is associated with a more acute onset and higher risk of mortality with ICU admission.
- CAPA patients, often immunodeficient and treated with corticosteroids, are prone to severe complications contributing to increased mortality.
- Understanding these differences is vital for optimizing treatment strategies for patients with viral-associated pulmonary aspergillosis.
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