tetano
Editor, Senior Moderator
Influenza Other Respir Viruses
. 2022 Nov 16.
doi: 10.1111/irv.13059. Online ahead of print.
Higher risk for influenza-associated pulmonary aspergillosis (IAPA) in asthmatic patients: A Swiss multicenter cohort study on IAPA in critically ill influenza patients
Frederike Waldeck[SUP] 1 [/SUP], Filippo Boroli[SUP] 2 [/SUP], Sandra Zingg[SUP] 3 [/SUP], Laura N Walti[SUP] 4 [/SUP], Pedro David Wendel-Garcia[SUP] 5 [/SUP], Anna Conen[SUP] 6 [/SUP], Jean-Luc Pagani[SUP] 7 [/SUP], Katia Boggian[SUP] 8 [/SUP], Madeleine Schnorf[SUP] 7 [/SUP], Martin Siegemund[SUP] 9 [/SUP], Samia Abed-Maillard[SUP] 7 [/SUP], Marc Michot[SUP] 10 [/SUP], Yok-Ai Que[SUP] 11 [/SUP], Veronika Bättig[SUP] 3 [/SUP], Noémie Suh[SUP] 2 [/SUP], Gian-Reto Kleger[SUP] 12 [/SUP], Werner C Albrich[SUP] 8 [/SUP]
Affiliations
Abstract
Background: Influenza-associated pulmonary aspergillosis (IAPA) is an important complication of severe influenza with high morbidity and mortality.
Methods: We conducted a retrospective multicenter study in tertiary hospitals in Switzerland during 2017/2018 and 2019/2020 influenza seasons. All adults with PCR-confirmed influenza infection and treatment on intensive-care unit (ICU) for >24 h were included. IAPA was diagnosed according to previously published clinical, radiological, and microbiological criteria. We assessed risk factors for IAPA and predictors for poor outcome, which was a composite of in-hospital mortality, ICU length of stay ≥7 days, mechanical ventilation ≥7 days, or extracorporeal membrane oxygenation.
Results: One hundred fifty-eight patients (median age 64 years, 45% females) with influenza were included, of which 17 (10.8%) had IAPA. Asthma was more common in IAPA patients (17% vs. 4% in non-IAPA, P = 0.05). Asthma (OR 12.0 [95% CI 2.1-67.2]) and days of mechanical ventilation (OR 1.1 [1.1-1.2]) were associated with IAPA. IAPA patients frequently required organ supportive therapies including mechanical ventilation (88% in IAPA vs. 53% in non-IAPA, P = 0.001) and vasoactive support (75% vs. 45%, P = 0.03) and had more complications including ARDS (53% vs. 26%, P = 0.04), respiratory bacterial infections (65% vs. 37%, P = 0.04), and higher ICU-mortality (35% vs. 16.4%, P = 0.05). IAPA (OR 28.8 [3.3-253.4]), influenza A (OR 3.3 [1.4-7.8]), and higher SAPS II score (OR 1.07 [1.05-1.10]) were independent predictors of poor outcome.
Interpretation: High clinical suspicion, early diagnostics, and therapy are indicated in IAPA because of high morbidity and mortality. Asthma is likely an underappreciated risk factor for IAPA.
Keywords: asthma; influenza; influenza-associated aspergillosis; intensive care medicine; invasive aspergillosis.
. 2022 Nov 16.
doi: 10.1111/irv.13059. Online ahead of print.
Higher risk for influenza-associated pulmonary aspergillosis (IAPA) in asthmatic patients: A Swiss multicenter cohort study on IAPA in critically ill influenza patients
Frederike Waldeck[SUP] 1 [/SUP], Filippo Boroli[SUP] 2 [/SUP], Sandra Zingg[SUP] 3 [/SUP], Laura N Walti[SUP] 4 [/SUP], Pedro David Wendel-Garcia[SUP] 5 [/SUP], Anna Conen[SUP] 6 [/SUP], Jean-Luc Pagani[SUP] 7 [/SUP], Katia Boggian[SUP] 8 [/SUP], Madeleine Schnorf[SUP] 7 [/SUP], Martin Siegemund[SUP] 9 [/SUP], Samia Abed-Maillard[SUP] 7 [/SUP], Marc Michot[SUP] 10 [/SUP], Yok-Ai Que[SUP] 11 [/SUP], Veronika Bättig[SUP] 3 [/SUP], Noémie Suh[SUP] 2 [/SUP], Gian-Reto Kleger[SUP] 12 [/SUP], Werner C Albrich[SUP] 8 [/SUP]
Affiliations
- PMID: 36394086
- DOI: 10.1111/irv.13059
Abstract
Background: Influenza-associated pulmonary aspergillosis (IAPA) is an important complication of severe influenza with high morbidity and mortality.
Methods: We conducted a retrospective multicenter study in tertiary hospitals in Switzerland during 2017/2018 and 2019/2020 influenza seasons. All adults with PCR-confirmed influenza infection and treatment on intensive-care unit (ICU) for >24 h were included. IAPA was diagnosed according to previously published clinical, radiological, and microbiological criteria. We assessed risk factors for IAPA and predictors for poor outcome, which was a composite of in-hospital mortality, ICU length of stay ≥7 days, mechanical ventilation ≥7 days, or extracorporeal membrane oxygenation.
Results: One hundred fifty-eight patients (median age 64 years, 45% females) with influenza were included, of which 17 (10.8%) had IAPA. Asthma was more common in IAPA patients (17% vs. 4% in non-IAPA, P = 0.05). Asthma (OR 12.0 [95% CI 2.1-67.2]) and days of mechanical ventilation (OR 1.1 [1.1-1.2]) were associated with IAPA. IAPA patients frequently required organ supportive therapies including mechanical ventilation (88% in IAPA vs. 53% in non-IAPA, P = 0.001) and vasoactive support (75% vs. 45%, P = 0.03) and had more complications including ARDS (53% vs. 26%, P = 0.04), respiratory bacterial infections (65% vs. 37%, P = 0.04), and higher ICU-mortality (35% vs. 16.4%, P = 0.05). IAPA (OR 28.8 [3.3-253.4]), influenza A (OR 3.3 [1.4-7.8]), and higher SAPS II score (OR 1.07 [1.05-1.10]) were independent predictors of poor outcome.
Interpretation: High clinical suspicion, early diagnostics, and therapy are indicated in IAPA because of high morbidity and mortality. Asthma is likely an underappreciated risk factor for IAPA.
Keywords: asthma; influenza; influenza-associated aspergillosis; intensive care medicine; invasive aspergillosis.