Department of Infectious Disease, the Hebei Medical University Third Hospital, No. 139, Ziqiang Road, Shijiazhuang, 050051, Hebei, China.
Hebei Clinical Medical Research Center of Infectious Diseases, Shijiazhuang, 050051, China.
Eur J Clin Microbiol Infect Dis. 2024 Apr;43(4):713-721. doi: 10.1007/s10096-024-04775-1. Epub 2024 Feb 12.
Patients with end-stage liver disease (ESLD) are susceptible to invasive pulmonary aspergillosis (IPA). This study aimed to investigate the risk factors affecting the occurrence and short-term prognosis of ESLD complicated by IPA.
This retrospective case-control study included 110 patients with ESLD. Of them, 27 ESLD-IPA received antifungal therapy with amphotericin B (AmB); 27 AmB-free-treated ESLD-IPA patients were enrolled through 1:1 propensity score matching. Fifty-six ESLD patients with other comorbid pulmonary infections were enrolled as controls. The basic features of groups were compared, while the possible risk factors affecting the occurrence and short-term outcomes of IPA were analyzed.
Data analysis revealed invasive procedures, glucocorticoid exposure, and broad-spectrum antibiotic use were independent risk factors for IPA. The 54 patients with ESLD-IPA exhibited an overall treatment effectiveness and 28-d mortality rate of 50.00% and 20.37%, respectively, in whom patients treated with AmB-containing showed higher treatment efficacy than patients treated with AmB-free antifungal regimens (66.7% vs. 33.3%, respectively, χ = 6.000, P = 0.014). Multivariate logistic regression analysis revealed that the treatment regimen was the only predictor affecting patient outcomes, with AmB-containing regimens were 4.893 times more effective than AmB-free regimens (95% CI, 1.367-17.515; P = 0.015). The only independent predictors affecting the 28-d mortality rate were neutrophil-to-lymphocyte ratio and IPA diagnosis (OR = 1.140 and 10.037, P = 0.046 and 0.025, respectively).
Glucocorticoid exposure, invasive procedures, and broad-spectrum antibiotic exposure increased the risk of IPA in ESLD patients. AmB alone or combined with other antifungals may serve as an economical, safe, and effective treatment option for ESLD-IPA.
终末期肝病（ESLD）患者易患侵袭性肺曲霉病（IPA）。本研究旨在探讨影响 ESLD 合并 IPA 发生和短期预后的相关因素。
本回顾性病例对照研究纳入了 110 例 ESLD 患者。其中，27 例 ESLD-IPA 患者接受两性霉素 B（AmB）抗真菌治疗；通过 1:1 倾向评分匹配，纳入 27 例 AmB 无治疗的 ESLD-IPA 患者。纳入 56 例患有其他合并肺部感染的 ESLD 患者作为对照。比较各组的基本特征，分析可能影响 IPA 发生和短期结局的相关因素。
数据分析显示，侵袭性操作、糖皮质激素暴露和广谱抗生素使用是 IPA 的独立危险因素。54 例 ESLD-IPA 患者的总体治疗有效率和 28 天死亡率分别为 50.00%和 20.37%，其中接受含 AmB 治疗的患者治疗效果优于接受 AmB 无抗真菌治疗的患者（分别为 66.7%和 33.3%，χ²=6.000，P=0.014）。多变量 logistic 回归分析显示，治疗方案是影响患者结局的唯一预测因素，含 AmB 方案的治疗效果是 AmB 无方案的 4.893 倍（95%CI，1.367-17.515；P=0.015）。唯一影响 28 天死亡率的独立预测因素是中性粒细胞与淋巴细胞比值和 IPA 诊断（OR=1.140 和 10.037，P=0.046 和 0.025）。
糖皮质激素暴露、侵袭性操作和广谱抗生素暴露增加了 ESLD 患者发生 IPA 的风险。AmB 单独或联合其他抗真菌药物可能是治疗 ESLD-IPA 的一种经济、安全、有效的选择。
