title: Prognostic factors in 194 patients with chronic necrotizing pulmonary aspergillosis.
abstract: OBJECTIVE
  The prognostic factors of chronic necrotizing pulmonary aspergillosis remain unclear. We assessed the prognostic factors of all-cause mortality in patients with chronic necrotizing pulmonary aspergillosis, focusing especially on underlying pulmonary disease, first-line treatment and host predisposition.
  
  
  METHODS
  We retrospectively analyzed the medical records of 194 patients negative for HIV who had chronic necrotizing pulmonary aspergillosis treated at our institution in Saitama, Japan.
  
  
  RESULTS
  The patients (median age, 68.5 years) were followed over a median follow-up time of 2.6 years. The underlying pulmonary diseases consisted of previous pulmonary tuberculosis in 59 (30.4%) patients, emphysema in 39 (20.1%) patients, interstitial lung disease in 32 (16.5%) patients, nontuberculous mycobacteriosis in 29 (14.9%) patients and other diseases in 35 (18%) patients. The first-line treatments included observation in 65 (33.5%) patients, itraconazole in 56 (28.9%) patients, micafungin in 46 (23.7%) patients, voriconazole in 22 (11.3%) patients and amphotericin B (including liposomal amphotericin B) in five (2.6%) patients. The overall cumulative mortality rate was 50.2% at five years and 67.4% at 10 years. Multivariate Cox proportional hazard modeling found an older age, the presence of systemic comorbidities, baseline corticosteroid use, a body mass index of <18.5 kg/m(2) and a C-reactive protein level of ≥5.0 mg/dL to be negative prognostic factors for all-cause mortality.
  
  
  CONCLUSIONS
  The 5-year mortality rate of chronic necrotizing pulmonary aspergillosis was 50.2%. When clinical trials are designed and implemented to test effective drug therapies in patients with chronic necrotizing pulmonary aspergillosis, the trial patients should be stratified according to these prognostic factors prior to randomization.
authors.affiliation: Department of Respiratory Medicine, Saitama Cardiovascular and Respiratory Center, Japan. keichon2000@yahoo.co.jp
authors.forename: Keitaro
authors.initials: K
authors.lastname: Nakamoto
authors.forename: Noboru
authors.initials: N
authors.lastname: Takayanagi
authors.forename: Tetsu
authors.initials: T
authors.lastname: Kanauchi
authors.forename: Takashi
authors.initials: T
authors.lastname: Ishiguro
authors.forename: Tsutomu
authors.initials: T
authors.lastname: Yanagisawa
authors.forename: Yutaka
authors.initials: Y
authors.lastname: Sugita
mesh_terms: D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D002097:C-Reactive Protein / Q000378:metabolism; D015331:Cohort Studies; D005260:Female; D005500:Follow-Up Studies; D006801:Humans; D055744:Invasive Pulmonary Aspergillosis / Q000097:blood / Q000175:diagnosis* / Q000453:epidemiology*; D008297:Male; D008875:Middle Aged; D011379:Prognosis; D012189:Retrospective Studies
chemical_list: D002097:C-Reactive Protein