title: Baseline platelet count and creatinine clearance rate predict the outcome of neutropenia-related invasive aspergillosis.
abstract: BACKGROUND
  Invasive aspergillosis (IA) is a life-threatening infection for immunocompromised patients. Improvement in IA outcome has been hampered by lack of early prognostic factors, namely, those available before starting chemotherapy (baseline) or early in the course of IA (nonbaseline). We hypothesized that prognostic factors can be identified before chemotherapy, ≤7 days from the first positive serum Aspergillus galactomannan index (s-GMI).
  
  
  METHODS
  We analyzed 98 patients with multiple myeloma who developed neutropenia-related IA and had a positive s-GMI. Three response criteria were used: kinetics of s-GMI, European Organization for Research and Treatment of Cancer/Invasive Fungal Infections Cooperative Group and the National Institute of Allergy and Infectious Diseases Mycoses Study Group (EORTC/MSG) definitions, and 6-week survival. Baseline and nonbaseline variables were analyzed separately.
  
  
  RESULTS
  Independent response predictors at baseline were a platelet count ≥65,000 platelets/mm(3) (odds ratio [OR], 1.009; 95% confidence interval [CI], 1.001-1.017; P = .03) by s-GMI kinetics, and a platelet count ≥65,000 platelets/mm(3) (OR, 1.009; 95% CI, 1.002-1.017; P = .01) and a creatinine clearance rate ≥53 mL/min (OR, 1.024; 95% CI, 1.006-1.042; P = .009) by EORTC/MSG criteria, with response rates of 83% and 28% when both variables were above or below these cutoffs, respectively (P < .001). Only baseline creatinine clearance rate ≥53 mL/min predicted 6-week survival (P = .003). Normalization of the s-GMI ≤7 days after the first positive s-GMI and neutrophil recovery were the nonbaseline factors associated with positive outcomes.
  
  
  CONCLUSIONS
  Two simple, inexpensive to measure, widely available, and routinely collected prechemotherapy values, platelet count and creatinine clearance rate, predict IA outcome and stratify patients into low-, intermediate-, and high-risk categories, while early evaluation of s-GMI allows timely treatment modification. These findings may improve patient outcomes by optimizing management strategies for this serious infection and may prove valuable in designing clinical trials of interventions to improve IA outcomes.
authors.affiliation: Department of Preventive Medicine, Universidade Federal do Rio de Janeiro, Brazil.
authors.forename: Simone Aranha
authors.initials: SA
authors.lastname: Nouér
authors.forename: Marcio
authors.initials: M
authors.lastname: Nucci
authors.forename: Naveen Sanath
authors.initials: NS
authors.lastname: Kumar
authors.forename: Monica
authors.initials: M
authors.lastname: Grazziutti
authors.forename: Alejandro
authors.initials: A
authors.lastname: Restrepo
authors.forename: Elias
authors.initials: E
authors.lastname: Anaissie
mesh_terms: D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D003404:Creatinine / Q000097:blood*; D005260:Female; D006801:Humans; D016867:Immunocompromised Host; D055744:Invasive Pulmonary Aspergillosis / Q000175:diagnosis* / Q000401:mortality*; D008297:Male; D008657:Metabolic Clearance Rate; D008875:Middle Aged; D009101:Multiple Myeloma / Q000150:complications*; D009503:Neutropenia / Q000150:complications / Q000175:diagnosis*; D010976:Platelet Count; D011379:Prognosis; D012189:Retrospective Studies; D016019:Survival Analysis; D016896:Treatment Outcome
chemical_list: D003404:Creatinine