Clinical features of invasive bronchial-pulmonary aspergillosis in critically ill patients with chronic respiratory diseases: a prospective study
贺航咏1 丁琳1 栗方1 詹庆元1
Department of Respiratory and Critical Care Medicine, Beijing Institute of Respiratory Medicine, Beijing Chao-Yang Hospital, Capital Medical University
Objective: To investigate the value of clinical characteristics and diagnostic studies for rapid recognition of invasive bronchial-pulmonary aspergillosis (IBPA) in critically ill patients with chronic respiratory diseases (CRD).
Methods:A prospective, single-center, cohort study in a respiratory intensive care unit of a university hospital. 55 consecutive patients with CRD admitted to respiratory intensive care unit (RICU) were included and 13 IBPA were diagnosed. They were divided into IBPA and control group.
Main Results: Compared with the control patients, IBPA patients received significantly higher total doses of corticosteroids (371mg vs 180 mg of prednisone or equivalent), and more kinds of broad-spectrum antibiotics (median 3 antibiotics for 10 days vs 2 types for 3 days) before their RICU admission. IBPA patients were more likely to have patching and nodules in chest X-ray at the 1st and 4th day after their RICU admission, and rapidly progressed into consolidation at day 7. The ropiness sputum is significantly more common in IBPA on day 1 under bronchoscopy (73% vs 13%, p=0.003). The sensitivity, specificity, and positive and negative predictive values for the detection of serum GM for IBPA in CRD patients were 53.8%, 81.0%, 46.7% and 85.0%, respectively. IBPA patients had higher APACHE II scores and white blood cell count, and were more likely to have dysfunction in multiple organ systems. All IBPA patients were mechanically ventilated. Despite strong support and appropriate antifungal treatment, the outcome is poor, with a mortality rate of 69.2%.
Conclusions: The risk factors for CRD patients with IBPA include high total dose of corticosteroids therapy and multiple kinds of antibiotic use. The clinical signs, combined with radiological examinations, bronchoscopic analysis, and serum GM test may suggest an early diagnosis of IBPA in critically ill CRD patients, so that prompt therapy could be implemented to give the patient optimal chance of cure.
