Emmanuel Pardo1, Virginie Lemiale1, Djamel Mokart2, Annabelle Stoclin3, Anne-Sophie Moreau4, Lionel Kerhuel1, Laure Calvet1, Sandrine Valade1, Audrey De Jong1, Michael Darmon1,5,6, Elie Azoulay7,8,9. 1. Médecine Intensive et Réanimation, APHP, Hôpital Saint-Louis, 1 avenue Claude Vellefaux, 75010, Paris, France. 2. ICU, Paoli Calmette Institute, Marseille, France. 3. Intensive Care Unit, Gustave Roussy, Villejuif, France. 4. Centre de Réanimation, CHRU Lille, Lille, France. 5. Faculté de Médecine, Université Paris-Diderot, Sorbonne-Paris-Cité, Paris, France. 6. ECSTRA Team, Biostatistics and Clinical Epidemiology, UMR 1153, (Center of Epidemiology and Biostatistic Sorbonne Paris Cité, CRESS), INSERM, Paris, France. 7. Médecine Intensive et Réanimation, APHP, Hôpital Saint-Louis, 1 avenue Claude Vellefaux, 75010, Paris, France. elie.azoulay@aphp.fr. 8. Faculté de Médecine, Université Paris-Diderot, Sorbonne-Paris-Cité, Paris, France. elie.azoulay@aphp.fr. 9. ECSTRA Team, Biostatistics and Clinical Epidemiology, UMR 1153, (Center of Epidemiology and Biostatistic Sorbonne Paris Cité, CRESS), INSERM, Paris, France. elie.azoulay@aphp.fr.
Abstract
PURPOSE: Invasive pulmonary aspergillosis (IPA) is a dreadful event in patients with hematological malignancies (HM). Recent advances have standardized diagnostic, prophylactic and curative therapeutic strategies. We sought to assess whether these advances actually translate into improved survival in critically ill patients with acute respiratory failure and IPA. METHODS: This was a retrospective, multicenter study. Adult patients with HM, IPA, admitted to the ICU for acute respiratory failure over a 20-year period (January 1998-December 2017) were included. A cox regression model was used to identify variables independently associated with day-90 survival. RESULTS: Overall, 219 patients were included [138 (63%) men, median age 55 (IQR 44-64)]. Acute myeloid leukemia (30.1%) and non-Hodgkin lymphoma (22.8%) were the most frequent malignancies, and 53 (24.2%) were allogeneic stem cell recipients. Day-1 SOFA score was 9 [7-12]. Most patients presented with probable IPA, whereas 15 (7%) underwent lung biopsies or pleurocentesis and met criteria for proven IPA. Overall ICU and day-90 mortality were, respectively, 58.4% and 75.2% (80.4% if invasive mechanical ventilation) without any significant improvement over time. By multivariable analysis adjusted on day-1 SOFA score and ventilation strategies, voriconazole use (HR 0.49, CI 95 0.34-0.73, p < 0.001) and an ICU admission after 2010 (HR 0.67, 0.45-0.99, p = 0.042) were associated with increased survival, whereas a diffuse radiologic pattern (HR 2.07, CI 95 1.33-3.24, p = 0.001) and delayed admission to the ICU (HR 1.51, CI 95 1.05-2.16, p = 0.026) were independently associated with increased mortality. CONCLUSIONS: IPA is associated with high mortality rates in critically ill patients with acute respiratory failure. Routine voriconazole and prompt ICU admission are warranted.
PURPOSE:Invasive pulmonary aspergillosis (IPA) is a dreadful event in patients with hematological malignancies (HM). Recent advances have standardized diagnostic, prophylactic and curative therapeutic strategies. We sought to assess whether these advances actually translate into improved survival in critically ill patients with acute respiratory failure and IPA. METHODS: This was a retrospective, multicenter study. Adult patients with HM, IPA, admitted to the ICU for acute respiratory failure over a 20-year period (January 1998-December 2017) were included. A cox regression model was used to identify variables independently associated with day-90 survival. RESULTS: Overall, 219 patients were included [138 (63%) men, median age 55 (IQR 44-64)]. Acute myeloid leukemia (30.1%) and non-Hodgkin lymphoma (22.8%) were the most frequent malignancies, and 53 (24.2%) were allogeneic stem cell recipients. Day-1 SOFA score was 9 [7-12]. Most patients presented with probable IPA, whereas 15 (7%) underwent lung biopsies or pleurocentesis and met criteria for proven IPA. Overall ICU and day-90 mortality were, respectively, 58.4% and 75.2% (80.4% if invasive mechanical ventilation) without any significant improvement over time. By multivariable analysis adjusted on day-1 SOFA score and ventilation strategies, voriconazole use (HR 0.49, CI 95 0.34-0.73, p < 0.001) and an ICU admission after 2010 (HR 0.67, 0.45-0.99, p = 0.042) were associated with increased survival, whereas a diffuse radiologic pattern (HR 2.07, CI 95 1.33-3.24, p = 0.001) and delayed admission to the ICU (HR 1.51, CI 95 1.05-2.16, p = 0.026) were independently associated with increased mortality. CONCLUSIONS:IPA is associated with high mortality rates in critically ill patients with acute respiratory failure. Routine voriconazole and prompt ICU admission are warranted.
Authors: Daniela Baracaldo-Santamaría; Juan David Cala-Garcia; Germán José Medina-Rincón; Luis Carlos Rojas-Rodriguez; Carlos-Alberto Calderon-Ospina Journal: Antibiotics (Basel) Date: 2022-05-12
Authors: Elie Azoulay; Lene Russell; Andry Van de Louw; Victoria Metaxa; Philippe Bauer; Pedro Povoa; José Garnacho Montero; Ignacio Martin Loeches; Sangeeta Mehta; Kathryn Puxty; Peter Schellongowski; Jordi Rello; Djamel Mokart; Virginie Lemiale; Adrien Mirouse Journal: Intensive Care Med Date: 2020-02-07 Impact factor: 17.440
Authors: Jannik Stemler; Caroline Bruns; Sibylle C Mellinghoff; Nael Alakel; Hamdi Akan; Michelle Ananda-Rajah; Jutta Auberger; Peter Bojko; Pranatharthi H Chandrasekar; Methee Chayakulkeeree; José A Cozzi; Elizabeth A de Kort; Andreas H Groll; Christopher H Heath; Larissa Henze; Marcos Hernandez Jimenez; Souha S Kanj; Nina Khanna; Michael Koldehoff; Dong-Gun Lee; Alina Mager; Francesco Marchesi; Rodrigo Martino-Bufarull; Marcio Nucci; Jarmo Oksi; Livio Pagano; Bob Phillips; Juergen Prattes; Athina Pyrpasopoulou; Werner Rabitsch; Enrico Schalk; Martin Schmidt-Hieber; Neeraj Sidharthan; Pere Soler-Palacín; Anat Stern; Barbora Weinbergerová; Aline El Zakhem; Oliver A Cornely; Philipp Koehler Journal: J Fungi (Basel) Date: 2020-03-13