Factors associated with mortality in transplant patients with invasive aspergillosis.
BACKGROUND
Invasive aspergillosis (IA) is an important cause of morbidity and mortality in hematopoietic stem cell transplant (HSCT) and solid organ transplant (SOT) recipients. The purpose of this study was to evaluate factors associated with mortality in transplant patients with IA.


METHODS
Transplant patients from 23 US centers were enrolled from March 2001 to October 2005 as part of the Transplant Associated Infection Surveillance Network. IA cases were identified prospectively in this cohort through March 2006, and data were collected. Factors associated with 12-week all-cause mortality were determined by logistic regression analysis and Cox proportional hazards regression.


RESULTS
Six-hundred forty-two cases of proven or probable IA were evaluated, of which 317 (49.4%) died by the study endpoint. All-cause mortality was greater in HSCT patients (239 [57.5%] of 415) than in SOT patients (78 [34.4%] of 227; P<.001). Independent poor prognostic factors in HSCT patients were neutropenia, renal insufficiency, hepatic insufficiency, early-onset IA, proven IA, and methylprednisolone use. In contrast, white race was associated with decreased risk of death. Among SOT patients, hepatic insufficiency, malnutrition, and central nervous system disease were poor prognostic indicators, whereas prednisone use was associated with decreased risk of death. Among HSCT or SOT patients who received antifungal therapy, use of an amphotericin B preparation as part of initial therapy was associated with increased risk of death.


CONCLUSIONS
There are multiple variables associated with survival in transplant patients with IA. Understanding these prognostic factors may assist in the development of treatment algorithms and clinical trials.
Baddley
John W
JW
Department of Medicine, Division of Infectious Diseases, University of Alabama at Birmingham, AL 35294-0006, USA. jbaddley@uab.edu
Andes
David R
DR
Marr
Kieren A
KA
Kontoyiannis
Dimitrios P
DP
Alexander
Barbara D
BD
Kauffman
Carol A
CA
Oster
Robert A
RA
Anaissie
Elias J
EJ
Walsh
Thomas J
TJ
Schuster
Mindy G
MG
Wingard
John R
JR
Patterson
Thomas F
TF
Ito
James I
JI
Williams
O Dale
OD
Chiller
Tom
T
Pappas
Peter G
PG
D000328:Adult; D000935:Antifungal Agents / Q000627:therapeutic use; D001228:Aspergillosis / Q000150:complications / Q000188:drug therapy / Q000401:mortality*; D015331:Cohort Studies; D005260:Female; D018380:Hematopoietic Stem Cell Transplantation / Q000401:mortality*; D006801:Humans; D008297:Male; D008875:Middle Aged; D016377:Organ Transplantation / Q000401:mortality*; D011183:Postoperative Complications / Q000401:mortality; D012307:Risk Factors
D000935:Antifungal Agents
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