title: Causes of death in a contemporary cohort of patients with invasive aspergillosis.
abstract: Information regarding the processes leading to death in patients with invasive aspergillosis (IA) is lacking. We sought to determine the causes of death in these patients, the role that IA played in the cause, and the timing of death. The factors associated with IA-related mortality are also analyzed. We conducted a multicenter study (2008-2011) of cases of proven and probable IA. The causes of death and whether mortality was judged to be IA-related or IA-unrelated were determined by consensus using a six-member review panel. A multivariate analysis was performed to determine risk factors for IA-related death. Of 152 patients with IA, 92 (60.5%) died. Mortality was judged to be IA-related in 62 cases and IA-unrelated in 30. The most common cause of IA-related death was respiratory failure (50/62 patients), caused primarily by Aspergillus infection, although also by concomitant infections or severe comorbidities. Progression of underlying disease and bacteremic shock were the most frequent causes of IA-unrelated death. IA-related mortality accounted for 98% and 87% of deaths within the first 14 and 21 days, respectively. Liver disease (HR 4.54; 95% CI, 1.69-12.23) was independently associated with IA-related mortality, whereas voriconazole treatment was associated with reduced risk of death (HR 0.43; 95% CI, 0.20-0.93). In conclusion, better management of lung injury after IA diagnosis is the main challenge for physicians to improve IA outcomes. There are significant differences in causes and timing between IA-related and IA-unrelated mortality and these should be considered in future research to assess the quality of IA care.
authors: Department of Infectious Diseases, Hospital Universitari de Bellvitge, IDIBELL (Institut d´Investigació Biomèdica de Bellvitge), Universitat de Barcelona, Barcelona, Spain; REIPI (Spanish Network for Research in Infectious Diseases), Barcelona, Spain.
authors: Carolina
authors: C
authors: Garcia-Vidal
authors: Hospital Universitari de la Vall d'Hebron, Barcelona, Spain.
authors: Maddalena
authors: M
authors: Peghin
authors: Hospital Clínic i Provincial de Barcelona, Barcelona, Spain.
authors: Carlos
authors: C
authors: Cervera
authors: Department of Infectious Diseases, Hospital Universitari de Bellvitge, IDIBELL (Institut d´Investigació Biomèdica de Bellvitge), Universitat de Barcelona, Barcelona, Spain; REIPI (Spanish Network for Research in Infectious Diseases), Barcelona, Spain.
authors: Carlota
authors: C
authors: Gudiol
authors: Hospital Universitari de la Vall d'Hebron, Barcelona, Spain.
authors: Isabel
authors: I
authors: Ruiz-Camps
authors: Hospital Clínic i Provincial de Barcelona, Barcelona, Spain.
authors: Asunción
authors: A
authors: Moreno
authors: Department of Infectious Diseases, Hospital Universitari de Bellvitge, IDIBELL (Institut d´Investigació Biomèdica de Bellvitge), Universitat de Barcelona, Barcelona, Spain.
authors: Cristina
authors: C
authors: Royo-Cebrecos
authors: Hospital Universitari de la Vall d'Hebron, Barcelona, Spain.
authors: Eva
authors: E
authors: Roselló
authors: Hospital Clínic i Provincial de Barcelona, Barcelona, Spain.
authors: Jordi Puig
authors: JP
authors: de la Bellacasa
authors: Department of Infectious Diseases, Hospital Universitari de Bellvitge, IDIBELL (Institut d´Investigació Biomèdica de Bellvitge), Universitat de Barcelona, Barcelona, Spain.
authors: Josefina
authors: J
authors: Ayats
authors: Department of Infectious Diseases, Hospital Universitari de Bellvitge, IDIBELL (Institut d´Investigació Biomèdica de Bellvitge), Universitat de Barcelona, Barcelona, Spain; REIPI (Spanish Network for Research in Infectious Diseases), Barcelona, Spain.
authors: Jordi
authors: J
authors: Carratalà
mesh_terms: D000368:Aged; D000935:Antifungal Agents / Q000627:therapeutic use; D001228:Aspergillosis / Q000150:complications / Q000175:diagnosis / Q000401:mortality*; D002423:Cause of Death; D005260:Female; D006801:Humans; D008297:Male; D008875:Middle Aged; D012189:Retrospective Studies; D012307:Risk Factors; D065819:Voriconazole / Q000627:therapeutic use
chemical_list: D000935:Antifungal Agents; D065819:Voriconazole