title: Factors associated with mortality in transplant patients with invasive aspergillosis.
abstract: 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.
authors.affiliation: Department of Medicine, Division of Infectious Diseases, University of Alabama at Birmingham, AL 35294-0006, USA. jbaddley@uab.edu
authors.forename: John W
authors.initials: JW
authors.lastname: Baddley
authors.forename: David R
authors.initials: DR
authors.lastname: Andes
authors.forename: Kieren A
authors.initials: KA
authors.lastname: Marr
authors.forename: Dimitrios P
authors.initials: DP
authors.lastname: Kontoyiannis
authors.forename: Barbara D
authors.initials: BD
authors.lastname: Alexander
authors.forename: Carol A
authors.initials: CA
authors.lastname: Kauffman
authors.forename: Robert A
authors.initials: RA
authors.lastname: Oster
authors.forename: Elias J
authors.initials: EJ
authors.lastname: Anaissie
authors.forename: Thomas J
authors.initials: TJ
authors.lastname: Walsh
authors.forename: Mindy G
authors.initials: MG
authors.lastname: Schuster
authors.forename: John R
authors.initials: JR
authors.lastname: Wingard
authors.forename: Thomas F
authors.initials: TF
authors.lastname: Patterson
authors.forename: James I
authors.initials: JI
authors.lastname: Ito
authors.forename: O Dale
authors.initials: OD
authors.lastname: Williams
authors.forename: Tom
authors.initials: T
authors.lastname: Chiller
authors.forename: Peter G
authors.initials: PG
authors.lastname: Pappas
mesh_terms: 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
chemical_list: D000935:Antifungal Agents
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