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Factors associated with mortality in transplant patients with invasive aspergillosis.

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Date
2010-06-15
Authors
Baddley, John W
Andes, David R
Marr, Kieren A
Kontoyiannis, Dimitrios P
Alexander, Barbara D
Kauffman, Carol A
Oster, Robert A
Anaissie, Elias J
Walsh, Thomas J
Schuster, Mindy G
Wingard, John R
Patterson, Thomas F
Ito, James I
Williams, O Dale
Chiller, Tom
Pappas, Peter G
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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 article
Subject
Adult
Antifungal Agents
Aspergillosis
Cohort Studies
Female
Hematopoietic Stem Cell Transplantation
Humans
Male
Middle Aged
Organ Transplantation
Postoperative Complications
Risk Factors
Permalink
https://hdl.handle.net/10161/4151
Published Version (Please cite this version)
10.1086/652768
Publication 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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Scholars@Duke

Alexander

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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