Clinical features of invasive pulmonary aspergillosis vs. colonization in COPD patients distributed by gold stage.
, Sanz F
, Hernandez JL
, Merlos S
, Malmierca E
, Garcia-Perez FJ
, Sanchez-Haya E
, Segarra M
, Garcia de la Llana F
, Granizo JJ
, Gimenez MJ
, Aguilar L
Infectious Diseases Dpt., Hospital Central de la Defensa Gomez Ulla, Gta. del Ejército s/n, 28047 Madrid, Spain.
To explore clinical features of invasive pulmonary aspergillosis (IPA) vs. colonization among hospitalized COPD patients.
Records of COPD patients with two respiratory cultures yielding Aspergillus were retrospectively reviewed. Cases categorized as proven/probable API or colonization was analyzed.
118 patients were identified: 70 (59.3%) colonized, 48 (40.7%) with API (42 probable, 6 proven). Higher percentage of IPA patients (vs. colonized) presented GOLD III + IV (77.1% vs. 57.1%, p = 0.025). IPA patients presented higher Charlson index (3.5 ± 2.5 vs. 2.6 ± 2.2, p = 0.027), higher rate of ICU admission (27.1% vs. 4.3%, p = 0.001) and worse prognosis (McCabe rapidly fatal category: 31.3% vs. 7.1%, p = 0.001). GOLD-I IPA patients presented risk factors other than COPD. Before hospitalization, 66.7% IPA and 28.6% colonized patients were taking steroids (p < 0.001). Antifungals were administered to 83.3% IPA and 21.4% colonized patients (p < 0.001). Mortality was higher among IPA vs. colonized patients, both in global (58.3% vs. 10.0%, p < 0.001), GOLD-I (75.0% vs. 10.0%, p = 0.041), GOLD-II (42.9% vs. 5.0%, p = 0.042) and GOLD-III patients (54.2% vs. 0.0%, p < 0.001), but not in GOLD-IV patients (69.2% vs. 31.3%, p = 0.066).
IPA should be suspected not only in GOLD-III and GOLD-IV COPD patients, with higher mortality in IPA vs. colonized patients for GOLD-II and -III COPD patients.
Copyright © 2012. Published by Elsevier Ltd.
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