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Risk factors for short-term prognosis of end-stage liver disease complicated by invasive pulmonary aspergillosis

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Abstract

Background and aim

Patients with end-stage liver disease (ESLD) are susceptible to invasive pulmonary aspergillosis (IPA). This study aimed to investigate the risk factors affecting the occurrence and short-term prognosis of ESLD complicated by IPA.

Methods

This retrospective case–control study included 110 patients with ESLD. Of them, 27 ESLD-IPA received antifungal therapy with amphotericin B (AmB); 27 AmB-free-treated ESLD-IPA patients were enrolled through 1:1 propensity score matching. Fifty-six ESLD patients with other comorbid pulmonary infections were enrolled as controls. The basic features of groups were compared, while the possible risk factors affecting the occurrence and short-term outcomes of IPA were analyzed.

Results

Data analysis revealed invasive procedures, glucocorticoid exposure, and broad-spectrum antibiotic use were independent risk factors for IPA. The 54 patients with ESLD-IPA exhibited an overall treatment effectiveness and 28-d mortality rate of 50.00% and 20.37%, respectively, in whom patients treated with AmB-containing showed higher treatment efficacy than patients treated with AmB-free antifungal regimens (66.7% vs. 33.3%, respectively, χ2 = 6.000, P = 0.014). Multivariate logistic regression analysis revealed that the treatment regimen was the only predictor affecting patient outcomes, with AmB-containing regimens were 4.893 times more effective than AmB-free regimens (95% CI, 1.367–17.515; P = 0.015). The only independent predictors affecting the 28-d mortality rate were neutrophil-to-lymphocyte ratio and IPA diagnosis (OR = 1.140 and 10.037, P = 0.046 and 0.025, respectively).

Conclusions

Glucocorticoid exposure, invasive procedures, and broad-spectrum antibiotic exposure increased the risk of IPA in ESLD patients. AmB alone or combined with other antifungals may serve as an economical, safe, and effective treatment option for ESLD-IPA.

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Data availability

The authors will supply the relevant data in response to reasonable requests, and the data are available on request from the corresponding author [wangyadong8060@126.com].

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Acknowledgements

We thank all of the study patients for their participation.

Funding

This study was funded by the Hebei Province Natural Science Foundation Program (grant no. H2023206042), the Excellent Talent Program for Clinical Medicine (grant no. ZF2023082), and the Hebei Medical Applicable Technology Tracking Project (grant no. GZ2023020).

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Author notes

  1. Weiyan Yu, Ying Xiao, and Yue Luo contributed equally to this work.

Authors and Affiliations

  1. Department of Infectious Disease, the Hebei Medical University Third Hospital, No. 139, Ziqiang Road, Shijiazhuang, 050051, Hebei, China

    Weiyan Yu, Ying Xiao, Yue Luo, Yangyang Hu, Ru Ji, Wei Wang, Zhinian Wu, Zeqiang Qi, Tingyu Guo, Yadong Wang & Caiyan Zhao

  2. Hebei Clinical Medical Research Center of Infectious Diseases, Shijiazhuang, 050051, China

    Weiyan Yu, Ru Ji, Wei Wang, Yadong Wang & Caiyan Zhao

  3. Public Health Clinical Center of Chengdu, Chengdu, 610011, China

    Yue Luo

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  1. Weiyan Yu
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Contributions

Weiyan Yu, Ying Xiao, and Yue Luo performed the clinical study and data analysis and drafted the manuscript and tables. Yangyang Hu, Ru Ji, Wei Wang, Zhinian Wu, Zeqiang Qi, and Tingyu Guo participated in the clinical study and collected the patients’ clinical data. Yadong Wang proposed the study; contributed to the data acquisition, analysis, and interpretation; and revised the manuscript. Caiyan Zhao participated in the research design and critically revised the manuscript. All authors approved the final manuscript.

Corresponding authors

Correspondence to Yadong Wang or Caiyan Zhao.

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Ethics approval

This study, which involved human participants, was reviewed and approved by the Human Medical Research Ethics Committee of the Hebei Medical University Third Hospital (approval no. K2022-004–1). All patients and their immediate family members approved the recruitment of patient data and provided written informed consent to participate in the study.

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The authors declare no competing interests.

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Yu, W., Xiao, Y., Luo, Y. et al. Risk factors for short-term prognosis of end-stage liver disease complicated by invasive pulmonary aspergillosis. Eur J Clin Microbiol Infect Dis 43, 713–721 (2024). https://doi.org/10.1007/s10096-024-04775-1

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