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. 2024 Apr;43(4):713-721.
doi: 10.1007/s10096-024-04775-1. Epub 2024 Feb 12.

Risk factors for short-term prognosis of end-stage liver disease complicated by invasive pulmonary aspergillosis

Weiyan Yu #  1   2 , Ying Xiao #  1 , Yue Luo #  1   3 , Yangyang Hu  1 , Ru Ji  1   2 , Wei Wang  1   2 , Zhinian Wu  1 , Zeqiang Qi  1 , Tingyu Guo  1 , Yadong Wang  4   5 , Caiyan Zhao  6   7
Affiliations

Risk factors for short-term prognosis of end-stage liver disease complicated by invasive pulmonary aspergillosis

Weiyan Yu et al. Eur J Clin Microbiol Infect Dis. 2024 Apr.

Abstract

Background and aim: Patients with end-stage liver disease (ESLD) are susceptible to invasive pulmonary aspergillosis (IPA). This study aimed to investigate the risk factors affecting the occurrence and short-term prognosis of ESLD complicated by IPA.

Methods: This retrospective case-control study included 110 patients with ESLD. Of them, 27 ESLD-IPA received antifungal therapy with amphotericin B (AmB); 27 AmB-free-treated ESLD-IPA patients were enrolled through 1:1 propensity score matching. Fifty-six ESLD patients with other comorbid pulmonary infections were enrolled as controls. The basic features of groups were compared, while the possible risk factors affecting the occurrence and short-term outcomes of IPA were analyzed.

Results: Data analysis revealed invasive procedures, glucocorticoid exposure, and broad-spectrum antibiotic use were independent risk factors for IPA. The 54 patients with ESLD-IPA exhibited an overall treatment effectiveness and 28-d mortality rate of 50.00% and 20.37%, respectively, in whom patients treated with AmB-containing showed higher treatment efficacy than patients treated with AmB-free antifungal regimens (66.7% vs. 33.3%, respectively, χ2 = 6.000, P = 0.014). Multivariate logistic regression analysis revealed that the treatment regimen was the only predictor affecting patient outcomes, with AmB-containing regimens were 4.893 times more effective than AmB-free regimens (95% CI, 1.367-17.515; P = 0.015). The only independent predictors affecting the 28-d mortality rate were neutrophil-to-lymphocyte ratio and IPA diagnosis (OR = 1.140 and 10.037, P = 0.046 and 0.025, respectively).

Conclusions: Glucocorticoid exposure, invasive procedures, and broad-spectrum antibiotic exposure increased the risk of IPA in ESLD patients. AmB alone or combined with other antifungals may serve as an economical, safe, and effective treatment option for ESLD-IPA.

Keywords: Amphotericin B; End-stage liver disease; Invasive pulmonary aspergillosis; Prognostic model; Risk factor.

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