Division of Infectious Diseases and Microbiology, University Hospital Schleswig Holstein, Campus Lübeck, Lübeck, Germany.
Division of Intensive Care, Geneva University Hospitals, Geneva, Switzerland.
Influenza Other Respir Viruses. 2023 Jan;17(1):e13059. doi: 10.1111/irv.13059. Epub 2022 Nov 16.
Influenza-associated pulmonary aspergillosis (IAPA) is an important complication of severe influenza with high morbidity and mortality.
We conducted a retrospective multicenter study in tertiary hospitals in Switzerland during 2017/2018 and 2019/2020 influenza seasons. All adults with PCR-confirmed influenza infection and treatment on intensive-care unit (ICU) for >24 h were included. IAPA was diagnosed according to previously published clinical, radiological, and microbiological criteria. We assessed risk factors for IAPA and predictors for poor outcome, which was a composite of in-hospital mortality, ICU length of stay ≥7 days, mechanical ventilation ≥7 days, or extracorporeal membrane oxygenation.
One hundred fifty-eight patients (median age 64 years, 45% females) with influenza were included, of which 17 (10.8%) had IAPA. Asthma was more common in IAPA patients (17% vs. 4% in non-IAPA, P = 0.05). Asthma (OR 12.0 [95% CI 2.1-67.2]) and days of mechanical ventilation (OR 1.1 [1.1-1.2]) were associated with IAPA. IAPA patients frequently required organ supportive therapies including mechanical ventilation (88% in IAPA vs. 53% in non-IAPA, P = 0.001) and vasoactive support (75% vs. 45%, P = 0.03) and had more complications including ARDS (53% vs. 26%, P = 0.04), respiratory bacterial infections (65% vs. 37%, P = 0.04), and higher ICU-mortality (35% vs. 16.4%, P = 0.05). IAPA (OR 28.8 [3.3-253.4]), influenza A (OR 3.3 [1.4-7.8]), and higher SAPS II score (OR 1.07 [1.05-1.10]) were independent predictors of poor outcome.
High clinical suspicion, early diagnostics, and therapy are indicated in IAPA because of high morbidity and mortality. Asthma is likely an underappreciated risk factor for IAPA.
流感相关性侵袭性肺曲霉病（IAPA）是一种严重流感的重要并发症，发病率和死亡率均很高。
我们在瑞士的三所三级医院进行了一项回顾性多中心研究，研究时间为 2017/2018 年和 2019/2020 年流感季节。所有 PCR 确诊流感感染并在重症监护病房（ICU）接受 >24 小时治疗的成年人均被纳入研究。根据先前发表的临床、影像学和微生物学标准诊断 IAPA。我们评估了 IAPA 的危险因素和不良预后的预测因素，不良预后的综合指标为院内死亡率、ICU 住院时间≥7 天、机械通气≥7 天或体外膜氧合。
共纳入 158 例流感患者（中位年龄 64 岁，45%为女性），其中 17 例（10.8%）患有 IAPA。IAPA 患者中哮喘更为常见（17%比非 IAPA 患者的 4%，P=0.05）。哮喘（OR 12.0 [95%CI 2.1-67.2]）和机械通气天数（OR 1.1 [1.1-1.2]）与 IAPA 相关。IAPA 患者经常需要器官支持治疗，包括机械通气（88%比非 IAPA 患者的 53%，P=0.001）和血管活性支持（75%比 45%，P=0.03），并且更常发生并发症，包括急性呼吸窘迫综合征（53%比 26%，P=0.04）、呼吸细菌感染（65%比 37%，P=0.04）和 ICU 死亡率更高（35%比 16.4%，P=0.05）。IAPA（OR 28.8 [3.3-253.4]）、甲型流感（OR 3.3 [1.4-7.8]）和 SAPS II 评分较高（OR 1.07 [1.05-1.10]）是不良预后的独立预测因素。
由于发病率和死亡率高，IAPA 患者需要高度的临床怀疑、早期诊断和治疗。哮喘可能是 IAPA 的一个被低估的危险因素。
