Factors associated with mortality in transplant patients with invasive aspergillosis.
Abstract
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; P<.001). Independent
poor 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.
Type
Journal articleSubject
AdultAntifungal Agents
Aspergillosis
Cohort Studies
Female
Hematopoietic Stem Cell Transplantation
Humans
Male
Middle Aged
Organ Transplantation
Postoperative Complications
Risk Factors
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https://hdl.handle.net/10161/4151Published Version (Please cite this version)
10.1086/652768Publication Info
Baddley, John W; Andes, David R; Marr, Kieren A; Kontoyiannis, Dimitrios P; Alexander,
Barbara D; Kauffman, Carol A; ... Pappas, Peter G (2010). Factors associated with mortality in transplant patients with invasive aspergillosis.
Clin Infect Dis, 50(12). pp. 1559-1567. 10.1086/652768. Retrieved from https://hdl.handle.net/10161/4151.This is constructed from limited available data and may be imprecise. To cite this
article, please review & use the official citation provided by the journal.
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Show full item recordScholars@Duke
Barbara Dudley Alexander
Professor of Medicine
Clinical research related to infectious complications of solid organ and bone marrow
transplantation, with a particular interest in the treatment and rapid diagnosis of
fungal disease. Training the next generation of Transplant Infectious Disease Physicians
is a special focus of mine as the Principal Investigator of our Interdisciplinary
T32 Training Program funded the NIH.

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