Prognostic factors for invasive aspergillosis in patients with haematological malignancies.
Reliable data defining risk factors for invasive aspergillosis (IA) in haematological patients are limited. Analysis of factors influencing IA-associated death is especially valuable in the light of recent progress in managing IA. Between 1997 and 2005 we evaluated factors influencing IA-attributable mortality. For univariate analyses we used Wilcoxon and log-rank test, and for multivariate analysis a Cox model of logistic backward regression was applied. Attributable mortality was 41% after 1 y. 50% of attributable deaths occurred within 6 weeks after IA diagnosis. Various parameters significantly correlated with death after IA: 1) uncontrolled malignancy (p =0.007); 2) extrapulmonary disease (p =0.0003); 3) stable disease, mixed response or progressive disease at first radiological evaluation (p =0.004); 4) proven IA (p =0.02); 5) IA > 110 d after PBSCT (p =0.0112). Prolonged duration of neutropenia was associated with increased mortality (p =0.0001). We observed a trend towards improved survival of IA during recent y (2003-2005). In a multivariate analysis, factors independently associated with attributable mortality included y of first diagnosis (p =0.0492), extrapulmonary IA (p =0.0353) and duration of neutropenia (p =0.0088). In conclusion, the identified risk factors may serve for the definition of high-risk situations. In these settings, increased efforts of prevention, early diagnosis and aggressive treatment of IA are warranted in order to improve survival.
Division of Infectious Diseases and Clinical Immunology, Department of Internal Medicine III (Haematology, Oncology, Rheumatology and Infectious Diseases), University Hospital of Ulm, Ulm. stefan.reuter@med.uni-duesseldorf.de
Stefan
S
Reuter
Winfried
W
Kern
Claudia
C
Zenz
Peter
P
Kern
D001228:Aspergillosis / Q000097:blood* / Q000175:diagnosis*; D016913:Blood Component Transfusion; D005260:Female; D019337:Hematologic Neoplasms / Q000382:microbiology*; D006801:Humans; D053208:Kaplan-Meier Estimate; D016015:Logistic Models; D008297:Male; D008875:Middle Aged; D015999:Multivariate Analysis; D011379:Prognosis; D016016:Proportional Hazards Models; D012189:Retrospective Studies; D018709:Statistics, Nonparametric