Values of radiological examinations for the diagnosis and prognosis of invasive bronchial-pulmonary aspergillosis in critically ill patients with chronic obstructive pulmonary diseases.
BACKGROUND
The important role of radiological examinations of invasive pulmonary aspergillosis (IPA) in patients with neutropenia has been well studied; however, little is known about IPA in critically ill chronic obstructive pulmonary disease (COPD) patients.


OBJECTIVE
To evaluate the value of radiological examinations in the diagnosis and prognosis of invasive bronchial-pulmonary aspergillosis (IBPA) in critically ill COPD patients.


METHODS
We included 61 critically ill COPD patients in the intensive care unit (ICU) in a retrospective, single-center cohort study.


RESULTS
All of the patients were classified as IBPA group (n = 21) or non-IBPA group (n = 40). The chest computed tomography (CT) image analysis showed that the IBPA group had the highest percent of patchiness (76.2%), followed by multiple nodules (33.3%), angio-invasive patterns (including halo sign, wedge consolidation and air-crescent sign/cavity with a relatively low percent of 19%, 19% and 28.5%, respectively), and the multiple nodules that were distributed along the airway provided the most specific image, with the highest specificity of 92.5%. Compared to the survivors in the IBPA group, non-surviving patients had a higher percent of large consolidation (0% vs. 45.5%, P = .035). When the new effusions appeared on a chest x-ray (CXR), the creatinine (140.4 μmol/L vs. 64.0 μmol/L, P = .010) and PaO2/FiO2(188 mm Hg vs. 222 mm Hg, P = .034) rate deteriorated.


CONCLUSIONS
Multiple nodules that were distributed along with broncho-vascular bundles were relatively common and specific in critically ill COPD patients with IBPA. Deteriorated CXR combined with specific laboratory examinations, even when appropriate antibiotics were used, could indicate a diagnosis of IBPA. Large consolidations might be considered as poor prognostic indicators.
Department of Respiratory and Critical Care Medicine, Beijing Institute of Respiratory Medicine, Beijing Chao-Yang Hospital, Capital Medical University, Beijing, P.R. China.|Department of Respiratory and Critical Care Medicine, China-Japan Friendship Hospital, Beijing, P.R. China.
Linna
L
Huang
Department of Respiratory and Critical Care Medicine, Beijing Institute of Respiratory Medicine, Beijing Chao-Yang Hospital, Capital Medical University, Beijing, P.R. China.
Hangyong
H
He
Department of Radiology, Beijing Chao-Yang Hospital, Capital Medical University, Beijing, P.R. China.
Yi
Y
Ding
Department of Respiratory and Critical Care Medicine, Beijing Institute of Respiratory Medicine, Beijing Chao-Yang Hospital, Capital Medical University, Beijing, P.R. China.
Jingjing
J
Jin
Department of Respiratory and Critical Care Medicine, China-Japan Friendship Hospital, Beijing, P.R. China.
Qingyuan
Q
Zhan
D000368:Aged; D000369:Aged, 80 and over; D001230:Aspergillus / Q000302:isolation & purification; D016022:Case-Control Studies; D016638:Critical Illness / Q000401:mortality; D005260:Female; D006801:Humans; D007362:Intensive Care Units / Q000706:statistics & numerical data; D055744:Invasive Pulmonary Aspergillosis / Q000000981:diagnostic imaging* / Q000382:microbiology* / Q000401:mortality; D008172:Lung Diseases, Fungal / Q000000981:diagnostic imaging* / Q000382:microbiology* / Q000401:mortality / Q000473:pathology; D008297:Male; D055613:Multiple Pulmonary Nodules / Q000000981:diagnostic imaging* / Q000473:pathology; D011379:Prognosis; D029424:Pulmonary Disease, Chronic Obstructive / Q000150:complications / Q000000981:diagnostic imaging* / Q000473:pathology / Q000503:physiopathology; D011859:Radiography / Q000379:methods*; D012189:Retrospective Studies; D014057:Tomography, X-Ray Computed / Q000379:methods
aspergillus; chronic obstructive pulmonary disease; invasive bronchial-pulmonary aspergillosis; radiology