tetano
Editor, Senior Moderator
Crit Care Med
. 2021 Feb 15.
doi: 10.1097/CCM.0000000000004861. Online ahead of print.
The Extend of Aspergillosis in Critically Ill Patients With Severe Influenza Pneumonia: A Multicenter Cohort Study
Anne Coste[SUP] 1 [/SUP], Aur?lien Fr?rou, Ana?s Raute, Francis Couturaud, Jean Morin, Pierre-Yves Egreteau, Fran?ois-Xavier Blanc, Jean Reignier, Jean-Marc Tadi?, Adissa Tran, Charlotte Pronier, Marianne Coste-Burel, Gilles Nevez, Jean-Pierre Gangneux, Patrice Le Pape, S?verine Ansart, Jean-Marie Tonnelier, C?dric Bretonni?re, C?cile Aubron
Affiliations
Abstract
Objectives: To determine the frequency and prognosis of invasive pulmonary aspergillosis in critically ill patients with severe influenza pneumonia.
Design: Retrospective multicenter cohort study.
Setting: Five French ICUs.
Patients: Patients with influenza admitted to ICU between 2009 and 2018.
Measurements and main results: Of the 524 patients admitted for severe influenza diagnosed with a positive airway reverse-transcriptase polymerase chain reaction test, 450 (86%) required mechanical ventilation. A lower respiratory tract sample yielded with Aspergillus (Asp+) in 28 patients (5.3%). Ten patients (1.9%) were diagnosed with putative or proven invasive pulmonary aspergillosis, based on the validated AspICU algorithm. A multivariate model was built to identify independent risk factors for Aspergillus-positive pulmonary culture. Factors independently associated with Aspergillus-positive culture were liver cirrhosis (odds ratio = 6.7 [2.1-19.4]; p < 0.01), hematologic malignancy (odds ratio = 3.3 [1.2-8.5]; p = 0.02), Influenza A(H1N1)pdm09 subtype (odds ratio = 3.9 [1.6-9.1]; p < 0.01), and vasopressor requirement (odds ratio = 4.1 [1.6-12.7]; p < 0.01). In-hospital mortality of Asp+ patients was 36% versus 21% in patients without Aspergillus-positive pulmonary culture (p = 0.09).
Conclusions: In this large retrospective multicenter cohort of critically ill patients, putative invasive pulmonary aspergillosis according to AspICU algorithm was a relatively rare complication of influenza. Patients at higher risk of Aspergillus pulmonary colonization included those with liver cirrhosis, hematologic malignancy, H1N1pdm09 influenza A virus, and requiring vasopressors. Our results provide additional data on the controversial association between severe influenza and invasive pulmonary aspergillosis. Reaching a consensual definition of invasive pulmonary aspergillosis becomes mandatory and confers further prospective research.
. 2021 Feb 15.
doi: 10.1097/CCM.0000000000004861. Online ahead of print.
The Extend of Aspergillosis in Critically Ill Patients With Severe Influenza Pneumonia: A Multicenter Cohort Study
Anne Coste[SUP] 1 [/SUP], Aur?lien Fr?rou, Ana?s Raute, Francis Couturaud, Jean Morin, Pierre-Yves Egreteau, Fran?ois-Xavier Blanc, Jean Reignier, Jean-Marc Tadi?, Adissa Tran, Charlotte Pronier, Marianne Coste-Burel, Gilles Nevez, Jean-Pierre Gangneux, Patrice Le Pape, S?verine Ansart, Jean-Marie Tonnelier, C?dric Bretonni?re, C?cile Aubron
Affiliations
- PMID: 33591000
- DOI: 10.1097/CCM.0000000000004861
Abstract
Objectives: To determine the frequency and prognosis of invasive pulmonary aspergillosis in critically ill patients with severe influenza pneumonia.
Design: Retrospective multicenter cohort study.
Setting: Five French ICUs.
Patients: Patients with influenza admitted to ICU between 2009 and 2018.
Measurements and main results: Of the 524 patients admitted for severe influenza diagnosed with a positive airway reverse-transcriptase polymerase chain reaction test, 450 (86%) required mechanical ventilation. A lower respiratory tract sample yielded with Aspergillus (Asp+) in 28 patients (5.3%). Ten patients (1.9%) were diagnosed with putative or proven invasive pulmonary aspergillosis, based on the validated AspICU algorithm. A multivariate model was built to identify independent risk factors for Aspergillus-positive pulmonary culture. Factors independently associated with Aspergillus-positive culture were liver cirrhosis (odds ratio = 6.7 [2.1-19.4]; p < 0.01), hematologic malignancy (odds ratio = 3.3 [1.2-8.5]; p = 0.02), Influenza A(H1N1)pdm09 subtype (odds ratio = 3.9 [1.6-9.1]; p < 0.01), and vasopressor requirement (odds ratio = 4.1 [1.6-12.7]; p < 0.01). In-hospital mortality of Asp+ patients was 36% versus 21% in patients without Aspergillus-positive pulmonary culture (p = 0.09).
Conclusions: In this large retrospective multicenter cohort of critically ill patients, putative invasive pulmonary aspergillosis according to AspICU algorithm was a relatively rare complication of influenza. Patients at higher risk of Aspergillus pulmonary colonization included those with liver cirrhosis, hematologic malignancy, H1N1pdm09 influenza A virus, and requiring vasopressors. Our results provide additional data on the controversial association between severe influenza and invasive pulmonary aspergillosis. Reaching a consensual definition of invasive pulmonary aspergillosis becomes mandatory and confers further prospective research.