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Erschienen in:

10.10.2019 | Original

Invasive pulmonary aspergillosis in critically ill patients with hematological malignancies

verfasst von: Emmanuel Pardo, Virginie Lemiale, Djamel Mokart, Annabelle Stoclin, Anne-Sophie Moreau, Lionel Kerhuel, Laure Calvet, Sandrine Valade, Audrey De Jong, Michael Darmon, Elie Azoulay

Erschienen in: Intensive Care Medicine | Ausgabe 12/2019

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Abstract

Purpose

Invasive pulmonary aspergillosis (IPA) is a dreadful event in patients with hematological malignancies (HM). Recent advances have standardized diagnostic, prophylactic and curative therapeutic strategies. We sought to assess whether these advances actually translate into improved survival in critically ill patients with acute respiratory failure and IPA.

Methods

This was a retrospective, multicenter study. Adult patients with HM, IPA, admitted to the ICU for acute respiratory failure over a 20-year period (January 1998–December 2017) were included. A cox regression model was used to identify variables independently associated with day-90 survival.

Results

Overall, 219 patients were included [138 (63%) men, median age 55 (IQR 44–64)]. Acute myeloid leukemia (30.1%) and non-Hodgkin lymphoma (22.8%) were the most frequent malignancies, and 53 (24.2%) were allogeneic stem cell recipients. Day-1 SOFA score was 9 [7‐12]. Most patients presented with probable IPA, whereas 15 (7%) underwent lung biopsies or pleurocentesis and met criteria for proven IPA. Overall ICU and day-90 mortality were, respectively, 58.4% and 75.2% (80.4% if invasive mechanical ventilation) without any significant improvement over time. By multivariable analysis adjusted on day-1 SOFA score and ventilation strategies, voriconazole use (HR 0.49, CI 95 0.34–0.73, p < 0.001) and an ICU admission after 2010 (HR 0.67, 0.45–0.99, p = 0.042) were associated with increased survival, whereas a diffuse radiologic pattern (HR 2.07, CI 95 1.33–3.24, p = 0.001) and delayed admission to the ICU (HR 1.51, CI 95 1.05–2.16, p = 0.026) were independently associated with increased mortality.

Conclusions

IPA is associated with high mortality rates in critically ill patients with acute respiratory failure. Routine voriconazole and prompt ICU admission are warranted.

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Titel: Invasive pulmonary aspergillosis in critically ill patients with hematological malignancies
verfasst von: Emmanuel Pardo
Virginie Lemiale
Djamel Mokart
Annabelle Stoclin
Anne-Sophie Moreau
Lionel Kerhuel
Laure Calvet
Sandrine Valade
Audrey De Jong
Michael Darmon
Elie Azoulay
Publikationsdatum: 10.10.2019
Verlag: Springer Berlin Heidelberg
Erschienen in: Intensive Care Medicine / Ausgabe 12/2019
Print ISSN: 0342-4642
Elektronische ISSN: 1432-1238
DOI: https://doi.org/10.1007/s00134-019-05789-6

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Invasive pulmonary aspergillosis in critically ill patients with hematological malignancies