Journal Article

Factors Associated with Mortality in Transplant Patients with Invasive Aspergillosis

John W. Baddley, David R. Andes, Kieren A. Marr, Dimitrios P. Kontoyiannis, Barbara D. Alexander, Carol A. Kauffman, Robert A. Oster, Elias J. Anaissie, Thomas J. Walsh, Mindy G. Schuster, John R. Wingard, Thomas F. Patterson, James I. Ito, O. Dale Williams, Tom Chiller and Peter G. Pappas

in Clinical Infectious Diseases

Published on behalf of Infectious Diseases Society of America

Volume 50, issue 12, pages 1559-1567
Published in print June 2010 | ISSN: 1058-4838
Published online June 2010 | e-ISSN: 1537-6591 | DOI: http://dx.doi.org/10.1086/652768
Factors Associated with Mortality in Transplant Patients with Invasive Aspergillosis

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Background. Invasive aspergillosis (IA) is an important cause of morbidity and mortality in hematopoietic stem cell transplant (HSCT) and solid organ transplant (SOT) recipients. The purpose of this study was to evaluate factors associated with mortality in transplant patients with IA.

Methods. Transplant patients from 23 US centers were enrolled from March 2001 to October 2005 as part of the Transplant Associated Infection Surveillance Network. IA cases were identified prospectively in this cohort through March 2006, and data were collected. Factors associated with 12-week all-cause mortality were determined by logistic regression analysis and Cox proportional hazards regression.

Results. Six-hundred forty-two cases of proven or probable IA were evaluated, of which 317 (49.4%) died by the study endpoint. All-cause mortality was greater in HSCT patients (239 [57.5%] of 415) than in SOT patients (78 [34.4%] of 227; ). Independent poor P < .001 prognostic factors in HSCT patients were neutropenia, renal insufficiency, hepatic insufficiency, early-onset IA, proven IA, and methylprednisolone use. In contrast, white race was associated with decreased risk of death. Among SOT patients, hepatic insufficiency, malnutrition, and central nervous system disease were poor prognostic indicators, whereas prednisone use was associated with decreased risk of death. Among HSCT or SOT patients who received antifungal therapy, use of an amphotericin B preparation as part of initial therapy was associated with increased risk of death.

Conclusions. There are multiple variables associated with survival in transplant patients with IA. Understanding these prognostic factors may assist in the development of treatment algorithms and clinical trials.

Journal Article.  4457 words.  Illustrated.

Subjects: Infectious Diseases ; Immunology ; Public Health and Epidemiology ; Microbiology

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