Zhang Xuan, Yang Meifang, Hu Jianhua, Zhao Hong, Li Lanjuan
State Key Laboratory for Diagnosis and Treatment of Infectious Diseases, Collaborative Innovation Center for Diagnosis and Treatment of Infectious Diseases, the First Affiliated Hospital, College of Medicine, Zhejiang University, Hangzhou, China.
J Int Med Res. 2018 Feb;46(2):819-827. doi: 10.1177/0300060517729907. Epub 2017 Sep 18.
Objective Invasive pulmonary aspergillosis (IPA) is a severe and often lethal infection. The possible risk factors, clinical presentation, and treatment of patients with simultaneous liver failure and IPA have received little attention in previous studies. The aim of this study was to investigate the epidemiology of IPA in patients with liver failure in an effort to reduce patient mortality. Methods The patients with liver failure (including acute liver failure , sub-acute liver failure , acute-on-chronic liver failure and chronic liver failure) were recruited from 2011 to 2016. The clinical data of these patients were retrieved for the study. Results In total, 1077 patients with liver failure were included in this study. Of the 1077 patients, 53 (4.9%) had IPA. Forty-four (83%) patients with IPA died. Independent risk factors for IPA were male sex (hazard ratio [HR] = 2.542), hepatorenal syndrome (HR = 2.463), antibiotic use (HR = 4.631), and steroid exposure (HR = 18.615). Conclusions IPA is a fatal complication in patients with liver failure. Male sex, hepatorenal syndrome, antibiotic use, and steroid exposure were independent risk factors for IPA. When patients with liver failure have these risk factors and symptoms of pneumonia such as cough or hemoptysis, clinicians should be cautious about the possibility of IPA.
目的 侵袭性肺曲霉病（IPA）是一种严重且常致命的感染。既往研究很少关注同时合并肝衰竭和IPA患者的可能危险因素、临床表现及治疗。本研究旨在调查肝衰竭患者中IPA的流行病学情况，以降低患者死亡率。方法 选取2011年至2016年的肝衰竭患者（包括急性肝衰竭、亚急性肝衰竭、慢加急性肝衰竭和慢性肝衰竭）。检索这些患者的临床资料进行研究。结果 本研究共纳入1077例肝衰竭患者。其中，53例（4.9%）患有IPA。44例（83%）IPA患者死亡。IPA的独立危险因素为男性（风险比[HR]=2.542）、肝肾综合征（HR=2.463）、使用抗生素（HR=4.631）和使用类固醇（HR=18.615）。结论 IPA是肝衰竭患者的致命并发症。男性、肝肾综合征、使用抗生素和使用类固醇是IPA的独立危险因素。当肝衰竭患者存在这些危险因素且有咳嗽或咯血等肺炎症状时，临床医生应警惕IPA的可能性。
