Factors associated with mortality in transplant patients with invasive aspergillosis

Baddley, John W.; Andes, David R.; Marr, Kieren A.; Kontoyiannis, Dimitrios P.; Alexander, Barbara D.; Kauffman, Carol A.; Oster, Robert A.; Anaissie, Elias J.; Walsh, Thomas J.; Schuster, Mindy G.; Wingard, John R.; Patterson, Thomas F.; Ito, James I.; Williams, O. Dale; Chiller, Tom; Pappas, Peter G.

doi:10.1086/652768

Cited by 303Antifungal resistance and susceptibilityImmunodeficiency and Autoimmune DisordersNeutropenia and Cancer Infections

Factors associated with mortality in transplant patients with invasive aspergillosis

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Baddley, John W., Andes, David R., Marr, Kieren A., Kontoyiannis, Dimitrios P., Alexander, Barbara D., Kauffman, Carol A., Oster, Robert A., Anaissie, Elias J. +8 more·2010·Clinical Infectious Diseases

DOI 10.1086/652768PMC PMC2874071

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Abstract

BACKGROUND: Invasive aspergillosis (IA) is an important cause of morbidity and mortality in hematopoietic stem cell transplant (HSCT) and solid organ transplant (SOT) recipients. The purpose of this study was to evaluate factors associated with mortality in transplant patients with IA. METHODS: Transplant patients from 23 US centers were enrolled from March 2001 to October 2005 as part of the Transplant Associated Infection Surveillance Network. IA cases were identified prospectively in this cohort through March 2006, and data were collected. Factors associated with 12-week all-cause mortality were determined by logistic regression analysis and Cox proportional hazards regression. RESULTS: Six-hundred forty-two cases of proven or probable IA were evaluated, of which 317 (49.4%) died by the study endpoint. All-cause mortality was greater in HSCT patients (239 [57.5%] of 415) than in SOT patients (78 [34.4%] of 227; P<.001). Independent poor prognostic factors in HSCT patients were neutropenia, renal insufficiency, hepatic insufficiency, early-onset IA, proven IA, and methylprednisolone use. In contrast, white race was associated with decreased risk of death. Among SOT patients, hepatic insufficiency, malnutrition, and central nervous system disease were poor prognostic indicators, whereas prednisone use was associated with decreased risk of death. Among HSCT or SOT patients who received antifungal therapy, use of an amphotericin B preparation as part of initial therapy was associated with increased risk of death. CONCLUSIONS: There are multiple variables associated with survival in transplant patients with IA. Understanding these prognostic factors may assist in the development of treatment algorithms and clinical trials.

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The global incidence of invasive aspergillosis was previously reported to be 200,000 cases with an associated mortality ranging from 30-80%, recently updated to >300,000 cases.
“The global incidence of invasive aspergillosis was previously reported to be 200,000 cases with an associated mortality ranging from 30–80% [108], recently updated to >300,000 cases [20].”
From Global and Multi-National Prevalence of Fungal Diseases-Estimate Precision (2017) · cites this paper as [108]
The Results report 12-week all-cause mortality of 49.4% among transplant patients with invasive aspergillosis, with rates of 57.5% and 34.4% in the two transplant groups. These figures fall within the cited 30–80% range, but the paper does not report that range or an estimate of 200,000 cases globally. The later update to more than 300,000 cases is attributed to a different citation. (LLM, conf=0.82)
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Associated Infection Surveillance Network
(2016)
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Invasive Aspergillosis following Hematopoietic Cell Transplantation: Outcomes and Prognostic Factors Associated with Mortality
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Aspergillosis after Hematopoietic Stem Cell Transplantation: A 1-Year Retrospective Study of Consecutive Patients at French
(2016)

Authors: Baddley, J. W., Andes, D. R., Marr, K. A., Kontoyiannis, D. P., Alexander, B. D., Kauffman, C. A., Oster, R. A., Anaissie, E. J., Walsh, T. J., Schuster, M. G., Wingard, J. R., Patterson, T. F., Ito, J. I., Williams, O. D., Chiller, T., & Pappas, P. G.
Affiliations: University of Alabama (US)
University of Wisconsin–Madison (US)
Johns Hopkins University (US)
The University of Texas MD Anderson Cancer Center (US)
Duke University (US)
University of Michigan (US)
University of Arkansas at Little Rock (US)
National Institutes of Health (US)
University of Pennsylvania (US)
University of Florida (US)
The University of Texas at San Antonio Health Science Center (US)
City Of Hope National Medical Center (US)
Centers for Disease Control and Prevention (US)
Corresponding author: Baddley, John W.
ORCID: Baddley, John W.
Andes, David R.
Marr, Kieren A.
Kontoyiannis, Dimitrios P.
Alexander, Barbara D.
Oster, Robert A.
Walsh, Thomas J.
Schuster, Mindy G.
Wingard, John R.
Patterson, Thomas F.
Chiller, Tom
Pappas, Peter G.
Venue: Clinical Infectious Diseases
Publisher: Oxford University Press (OUP)
Published: 2010-06-15
Volume: 50
Issue: 12
Pages: 1559-1567
ISSN: 1058-4838 (ISSN-L)
1537-6591
DOI: 10.1086/652768
PMC: PMC2874071
OpenAlex: W2133167433
Cited by: 303
References: 32
Citations by year: 2026: 7 · 2025: 14 · 2024: 13 · 2023: 13 · 2022: 14 · 2021: 13 · 2020: 17 · 2019: 16 · 2018: 10 · 2017: 29 · 2016: 30 · 2015: 29 · 2014: 20 · 2013: 18 · 2012: 30
FWCI: 16.18
Type: journal article
Language: en
Open access: bronze
doi.org
Locations: Clinical Infectious Diseases (publishedVersion)
PubMed (publishedVersion)
Europe PMC (PubMed Central) (acceptedVersion)
PubMed Central (acceptedVersion)
DukeSpace (Duke University) (submittedVersion, cc-by-nc-nd)
Funders: National Institutes of Health (and K24)
Centers for Disease Control and Prevention
National Institute of Allergy and Infectious Diseases (K24AI072522, K23AI064613)
Topics: Health Sciences › Medicine › Infectious Diseases › Antifungal resistance and susceptibility
Life Sciences › Immunology and Microbiology › Immunology › Immunodeficiency and Autoimmune Disorders
Health Sciences › Medicine › Oncology › Neutropenia and Cancer Infections
Keywords: invasive aspergillosis, mortality, hematopoietic stem cell transplantation, solid organ transplantation, prognostic factors, neutropenia, renal failure, liver dysfunction, methylprednisolone, amphotericin B, antifungal therapy, malnutrition, central nervous system disorders, race
MeSH terms: Adult, Antifungal Agents, Aspergillosis, Female, Humans, Male, Middle Aged, Postoperative Complications, Risk Factors, Cohort Studies, Organ Transplantation, Hematopoietic Stem Cell Transplantation

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Factors associated with mortality in transplant patients with invasive aspergillosis

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