Clinical features and prognostic analysis of patients with Aspergillus isolation during acute exacerbation of chronic obstructive pulmonary disease

Abstract

Background: Lower respiratory tract (LRT) specimen culture is widely performed for the identification of Aspergillus. We investigated the clinical features and prognosis of patients with Aspergillus isolation from LRT specimens during acute exacerbation of chronic obstructive pulmonary disease (AECOPD).

Methods: This is a 6-year single-center, real-world study. 75 cases out of 1131 hospitalized AECOPD patients were positive for Aspergillus. These patients were carefully evaluated and finally diagnosed of pulmonary aspergillosis (PA, 60 cases, 80%) or colonization (15 cases, 20%). Comparisons of clinical data were performed between these two groups. A cox regression model was used to confirm prognostic factors of Aspergillus infection.

Results: The PA group had worse lung function and higher rates of systemic corticosteroid use and broad-spectrum antibiotic use before admission than the colonization group. The PA group had significantly higher in-hospital mortality and 180-day mortality than the colonization group (45% (27/60) vs. 0% (0/15), p = 0.001, and 52.5% (31/59) vs. 6.7% (1/15), p < 0.001, respectively). By multivariable analysis among Aspergillus infection patients, antifungal therapy (HR 0.383, 95% CI 0.163-0.899, p = 0.027) was associated with improved survival, whereas accumulated dose of systemic steroids > 700 mg (HR 2.452, 95% CI 1.134-5.300, p = 0.023) and respiratory failure at admission (HR 5.983, 95% CI 2.487-14.397, p < 0.001) were independently associated with increased mortality. Significant survival differential was observed among PA patients without antifungals and antifungals initiated before and after Aspergillus positive culture (p = 0.001).

Conclusions: Aspergillus isolation in hospitalized AECOPD patients largely indicated PA. AECOPD patients with PA had worse prognosis than those with Aspergillus colonization. Empirical antifungal therapy is warranted to improve the prognosis for Aspergillus infection.

Keywords: AECOPD; Aspergillus isolation; Colonization; Prognosis; Pulmonary aspergillosis.

Fig. 1

Survival from admission to day 180 in patients in the PA and colonization groups according to Kaplan–Meier analysis with the log-rank test (p = 0.003)

Fig. 2

Forest plot of prognostic factors independently associated with 180-day mortality in Aspergillus infection patients

Fig. 3

Kaplan–Meier cumulative survival curve of PA patients in the 3 subgroups. Curves were compared with the log‑rank test (p = 0.001)

Fig. 4

Survival from admission to 180 day of patients with monotherapy and combination antifungal therapy by Kaplan–Meier analysis with log-rank test (p = 0.427)