Clinical Features And Prognosis Of Severe Non-granulocytic Patients With Invasive Pulmonary Aspergillosis

Objective:To explore the clinical features and survival factors of severe non-granulocytic patients complicated with invasive pulmonary aspergillosis(IPA),so as to provide evidence for early identification,diagnosis and treatment and improvement of prognosis.Methods:The ICU patients with severe IPA admitted to the Second Hospital of Hebei Medical University in recent 3 years were retrospectively analyzed and divided into survival group and death group.General information,complicated diseases,clinical manifestations,laboratory indicators,imaging and bronchoscopy findings,treatment and prognosis of patients were collected.Multivariate logistic regression analysis was performed on statistically significant variables in univariate analysis,and patient operating characteristic curve(ROC)was drawn to evaluate the predictive value of each indicator for survival of patients with severe IPA.Results:A total of 86 patients were included,including 44 patients(51.2%)who survived severe IPA and 42 patients(48.8%)who died.Univariate analysis showed Sequential Organ Failure Assessment,imaging findings of voids,antifungal efficacy,and sepsis were associated with survival in patients with severe IPA(P<0.05).Multiple factors analysis,according to the results of albumin(χ~2=8.254,OR=0.885,95%CI=0.768-0.951),the SOFA score(χ~2=5.018,OR=1.139,95%CI=1.016-1.276).Albumin and SOFA score are severe IPA independent risk factors for survival.When the AUC area of ROC was 0.931 and the cut-off value was 11,the sensitivity was 97.6%and the specificity was 87.1%.Conclusion:1.Non-granulocytic IPA patients in intensive care have atypical symptoms,lack of specificity in imaging,poor effect of conventional anti-infection therapy,difficult to improve oxygenation,refractory fever,and difficult to explain the infiltrating shadow suggested by imaging,and should be alert to the possibility of IPA.2.Male,old age,hypoproteinemia,pulmonary imaging voids,invasive mechanical ventilation,high SOFA score,poor antifungal treatment effect,and sepsis were independent risk factors affecting the survival of IPA patients,among which SOFA score had the greatest value in predicting the survival of IPA patients.