title: Risk factors for invasive pulmonary aspergillosis and hospital mortality in acute-on-chronic liver failure patients: a retrospective-cohort study.
abstract: BACKGROUND
  Invasive pulmonary aspergillosis (IPA) in acute-on-chronic liver failure (ACLF) patients is associated with a high mortality. But the clinical characteristics of and the risk factors for IPA among patients with ACLF remains unclear. This study was aimed at assessing clinical manifestation, the risk factors and antifungal medications for as well as the mortality due to IPA in ACLF patients at the First Affiliated Hospital, College of Medicine, Zhejiang University.
  
  
  METHODS
  Patients with ACLF who were diagnosed with proven or probable IPA by clinical and laboratory parameters from 1 December 2008 to 1 May 2012 were retrospectively evaluated to determine the risk factors for IPA and the clinical outcomes. The follow-up ended on 30 July 2012. Multivariate analysis was performed to identify the risk factors for mortality and the development of IPA.
  
  
  RESULTS
  In total, 787 patients with ACLF were enrolled, and 39 of these patients developed IPA. Thirty seven of these 39 patients died in spite of treatment with antifungal drugs. Controls included 48 patients who did not have a pulmonary infection. The survival rate of patients with IPA was significantly lower than that of those without IPA. IPA was found to be independently associated with age (p = 0.021), encephalopathy (p = 0.002), and steroid use (p = 0.000). There was significant difference in the prognosis between the patients treated with either voriconazole or itraconazole and those without antifungal treatment.
  
  
  CONCLUSIONS
  Patients with ACLF and IPA have a high mortality rate. Patients with ACLF who present with encephalopathy should avoid steroids, as they increase the mortality rate. Azoles may prolong the survival time.
authors.affiliation: 1. State Key Laboratory for Diagnosis and Treatment of Infectious Diseases, First Affiliated Hospital, College of Medicine, Zhejiang University, Hangzhou, China.
authors.forename: Jiajia
authors.initials: J
authors.lastname: Chen
authors.forename: Qing
authors.initials: Q
authors.lastname: Yang
authors.forename: Jianrong
authors.initials: J
authors.lastname: Huang
authors.forename: Lanjuan
authors.initials: L
authors.lastname: Li
mesh_terms: D000328:Adult; D000935:Antifungal Agents / Q000008:administration & dosage; D003428:Cross Infection / Q000188:drug therapy / Q000401:mortality* / Q000473:pathology; D058625:End Stage Liver Disease / Q000150:complications / Q000188:drug therapy* / Q000401:mortality* / Q000473:pathology; D005260:Female; D006801:Humans; D055744:Invasive Pulmonary Aspergillosis / Q000150:complications / Q000188:drug therapy* / Q000401:mortality* / Q000473:pathology; D017964:Itraconazole / Q000008:administration & dosage; D008297:Male; D008875:Middle Aged; D011743:Pyrimidines / Q000008:administration & dosage; D012307:Risk Factors; D015996:Survival Rate; D014230:Triazoles / Q000008:administration & dosage; D065819:Voriconazole
chemical_list: D000935:Antifungal Agents; D011743:Pyrimidines; D014230:Triazoles; D017964:Itraconazole; D065819:Voriconazole
keywords: Antifungal agents; Invasive pulmonary aspergillosis; Liver failure