• Intensive care medicine · Dec 2019

    Multicenter Study

    Invasive pulmonary aspergillosis in critically ill patients with hematological malignancies.

    • Emmanuel Pardo, Virginie Lemiale, Djamel Mokart, Annabelle Stoclin, Anne-Sophie Moreau, Lionel Kerhuel, Laure Calvet, Sandrine Valade, Audrey De Jong, Michael Darmon, and Elie Azoulay.
    • Médecine Intensive et Réanimation, APHP, Hôpital Saint-Louis, 1 avenue Claude Vellefaux, 75010, Paris, France.
    • Intensive Care Med. 2019 Dec 1; 45 (12): 1732-1741.

    PurposeInvasive 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.MethodsThis 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.ResultsOverall, 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.ConclusionsIPA is associated with high mortality rates in critically ill patients with acute respiratory failure. Routine voriconazole and prompt ICU admission are warranted.

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