Invasive pulmonary aspergillosis in immunocompetent patients hospitalised with influenza A-related pneumonia: a multicen
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RESEARCH ARTICLE
Open Access
Invasive pulmonary aspergillosis in immunocompetent patients hospitalised with influenza A-related pneumonia: a multicenter retrospective study Liang Chen1* , Xiudi Han2, Yanli Li3, Chunxiao Zhang4 and Xiqian Xing5
Abstract Background: Increasing cases of pulmonary aspergillosis (IPA) in immunocompetent patients with severe influenza have been reported. Howevere, the risk factors for occurence and death are largely unknown. Methods: Data of hospitalised patients with influenza A-related pneumonia (FluA-p) obtained from five teaching hospitals from 2031 to 2018, were reviewed. Univariate and multivariate logistical regression analyses were performed to determine the risk factors involved in the acquisition and 60-day mortality in IPA patients. Results: Of the 693 FluA-p patients included in the study, 3.0% (21/693) were IPA patients with a 60-day mortality of 42.9% (9/21). Adjusted for confounders, a Cox proportional hazard model showed that IPA was associated with increased risk for 60-day mortality [hazard ratio (HR) 4.336, 95% confidence interval (CI) 1.191–15.784, p = 0.026] in FluA-p patients. A multivariate logistic regression model confirmed that age (odd ratio (OR) 1.147, 95% CI 1.048– 1.225, p = 0.003), systemic corticosteroids use before IPA diagnosis (OR 33.773, 95% CI 5.681–76.764, p < 0.001), leukocytes > 10 × 109/L (OR 1.988, 95% CI 1.028–6.454, p = 0.029) and lymphocytes < 0.8 × 109/L on admission (OR 34.813, 95% CI 1.676–73.006, p = 0.022), were related with the acquisition of IPA. Early neuraminidase inhibitor use (OR 0.290, 95% CI 0.002–0.584, p = 0.021) was associated with a decreased risk for a 60-day mortality in IPA patients. Conclusions: Our results showed that IPA worsen the clinical outcomes of FluA-p patients. The risk factors for the acquisition and death were helpful for the clinicians in preventing and treating IPA. Keywords: Influenza A, Pneumonia, Invasive pulmonary aspergillosis, Risk factor
Background Influenza is a respiratory infectious disease, caused by influenza viruses, and which can present seasonal epidemics and pandemics [1, 2]. Despite the progress in medical technologies and economic development, influenza still causes considerate complications and mortality [3]. Following infection by influenza viruses, patients can * Correspondence: [email protected] 1 Department of Infectious Diseases, Beijing Jishuitan Hospital, 4th Medical College of Peking University, Beijing, China Full list of author information is available at the end of the article
show a broad spectrum of clinical symptoms, ranging from self-limited upper respiratory tract illness to severe pneumonia and acute respiratory distress syndrome (ARDS) [4]. It was estimated that every year, 10–20% of the global population experienced symptomatic influenza, including 3–5 million severe illnesses and 260–640 thousand deaths [5]. Nearly half of severe influenza patients present with pneumonia, which is mostly caused by influenza A [6]. Influenza pneumonia is often coinfected with ot
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