Department of Infectious Diseases, Beijing Jishuitan Hospital, 4th Medical College of Peking University, Beijing, China.
Department of Pulmonary and Critical Care Medicine, Qingdao Municipal Hospital, Qingdao City, Shandong Province, China.
BMC Pulm Med. 2020 Sep 9;20(1):239. doi: 10.1186/s12890-020-01257-w.
Increasing cases of pulmonary aspergillosis (IPA) in immunocompetent patients with severe influenza have been reported. Howevere, the risk factors for occurence and death are largely unknown.
Data of hospitalised patients with influenza A-related pneumonia (FluA-p) obtained from five teaching hospitals from 2031 to 2018, were reviewed. Univariate and multivariate logistical regression analyses were performed to determine the risk factors involved in the acquisition and 60-day mortality in IPA patients.
Of the 693 FluA-p patients included in the study, 3.0% (21/693) were IPA patients with a 60-day mortality of 42.9% (9/21). Adjusted for confounders, a Cox proportional hazard model showed that IPA was associated with increased risk for 60-day mortality [hazard ratio (HR) 4.336, 95% confidence interval (CI) 1.191-15.784, p = 0.026] in FluA-p patients. A multivariate logistic regression model confirmed that age (odd ratio (OR) 1.147, 95% CI 1.048-1.225, p = 0.003), systemic corticosteroids use before IPA diagnosis (OR 33.773, 95% CI 5.681-76.764, p < 0.001), leukocytes > 10 × 10/L (OR 1.988, 95% CI 1.028-6.454, p = 0.029) and lymphocytes < 0.8 × 10/L on admission (OR 34.813, 95% CI 1.676-73.006, p = 0.022), were related with the acquisition of IPA. Early neuraminidase inhibitor use (OR 0.290, 95% CI 0.002-0.584, p = 0.021) was associated with a decreased risk for a 60-day mortality in IPA patients.
Our results showed that IPA worsen the clinical outcomes of FluA-p patients. The risk factors for the acquisition and death were helpful for the clinicians in preventing and treating IPA.
免疫功能正常的重症流感患者中，侵袭性肺曲霉病（IPA）的病例不断增加。然而，IPA 的发病和死亡风险因素很大程度上仍不清楚。
本研究回顾了 2031 年至 2018 年间来自五所教学医院的因甲型流感相关性肺炎（FluA-p）住院的患者数据。采用单因素和多因素逻辑回归分析确定 IPA 患者发生和 60 天死亡率的相关风险因素。
在纳入的 693 例 FluA-p 患者中，3.0%（21/693）为 IPA 患者，60 天死亡率为 42.9%（9/21）。经混杂因素校正后，Cox 比例风险模型显示，IPA 与 FluA-p 患者 60 天死亡率增加相关[风险比（HR）4.336，95%置信区间（CI）1.191-15.784，p=0.026]。多因素逻辑回归模型证实，年龄（比值比（OR）1.147，95%CI 1.048-1.225，p=0.003）、IPA 诊断前全身皮质类固醇的使用（OR 33.773，95%CI 5.681-76.764，p<0.001）、白细胞计数>10×10/L（OR 1.988，95%CI 1.028-6.454，p=0.029）和入院时淋巴细胞计数<0.8×10/L（OR 34.813，95%CI 1.676-73.006，p=0.022）与 IPA 的发生相关。早期使用神经氨酸酶抑制剂（OR 0.290，95%CI 0.002-0.584，p=0.021）与 IPA 患者 60 天死亡率降低相关。
我们的研究结果表明，IPA 使 FluA-p 患者的临床结局恶化。IPA 的发病和死亡风险因素有助于临床医生预防和治疗 IPA。
