title: Invasive pulmonary aspergillosis in patients with acute-on-chronic liver failure.
abstract: OBJECTIVE
  Patients with acute-on-chronic liver failure (AoCLF) are prone to various infections, including invasive pulmonary aspergillosis (IPA). This retrospective study investigated the relationship between AoCLF and IPA in a large patient cohort.
  
  
  METHODS
  Twenty-nine out of 470  patients with AoCLF, who were diagnosed with definite or probable IPA by clinical and laboratory parameters and were treated with voriconazole, were analysed for predisposing factors for IPA and clinical outcome.
  
  
  RESULTS
  Imaging findings, such as the halo sign and increased white blood cell  count, contributed to the early diagnosis of IPA. Patients with AoCLF and IPA experienced fever, cough and chest pain and, despite treatment with antifungal therapy, most (25/29 patients) died within 7 days. Possible risk factors for IPA included prolonged antibiotic therapy and dexamethasone  exposure.
  
  
  CONCLUSIONS
  AoCLF with prolonged antibiotic therapy and dexamethasone exposure carries a high risk for IPA. AoCLF patients with IPA involved in this study exhibited fever, cough, chest pain and increased white blood cell count, and their imaging findings were useful for the early  diagnosis of IPA.
authors.affiliation: State Key Laboratory for Diagnosis and Treatment of Infectious Diseases, Department of Infectious Diseases, The First Affiliated Hospital, College of Medicine, Zhejiang University, Hangzhou, Zhejiang, China.
authors.forename: Z
authors.initials: Z
authors.lastname: Wu
authors.forename: Z
authors.initials: Z
authors.lastname: Ling
authors.forename: F
authors.initials: F
authors.lastname: Shao
authors.forename: J
authors.initials: J
authors.lastname: Sheng
authors.forename: L
authors.initials: L
authors.lastname: Li
mesh_terms: D000328:Adult; D000368:Aged; D000900:Anti-Bacterial Agents / Q000008:administration & dosage; D000935:Antifungal Agents / Q000008:administration & dosage; D004359:Drug Therapy, Combination; D005260:Female; D019694:Hepatitis B, Chronic / Q000150:complications* / Q000188:drug therapy / Q000401:mortality; D006801:Humans; D055744:Invasive Pulmonary Aspergillosis / Q000188:drug therapy / Q000209:etiology* / Q000401:mortality; D017114:Liver Failure, Acute / Q000150:complications* / Q000188:drug therapy / Q000401:mortality; D008297:Male; D008875:Middle Aged; D011743:Pyrimidines / Q000008:administration & dosage; D012189:Retrospective Studies; D016896:Treatment Outcome; D014230:Triazoles / Q000008:administration & dosage; D065819:Voriconazole
chemical_list: D000900:Anti-Bacterial Agents; D000935:Antifungal Agents; D011743:Pyrimidines; D014230:Triazoles; D065819:Voriconazole