Factors associated with mortality in transplant patients with invasive aspergillosis.
Factors associated with mortality in transplant patients with invasive aspergillosis.
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DOI：
10.1086/652768
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发表时间：
2010-06-15
期刊：
影响因子：
--
通讯作者：
Pappas PG
中科院分区：
文献类型：
--
作者：
Baddley JW;Andes DR;Marr KA;Kontoyiannis DP;Alexander BD;Kauffman CA;Oster RA;Anaissie EJ;Walsh TJ;Schuster MG;Wingard JR;Patterson TF;Ito JI;Williams OD;Chiller T;Pappas PG
侵袭性曲霉病(IA)是导致造血干细胞(HSCT)和实体器官移植(SOT)受者发病和死亡的重要原因。这项研究的目的是评估与移植后IA患者死亡率相关的因素。2001年3月至2005年10月，来自23个美国中心的移植患者作为移植相关感染监测网络(Transnet)的一部分进行了登记。到2006年3月，在这个队列中前瞻性地确定了IA病例，并收集了数据。通过Logistic回归分析和COX比例风险回归分析，确定与12周全因死亡率相关的因素。对642例确诊或可能的IA病例进行了评估，其中317例(49.4%)在研究终点前死亡。与SOT患者(78/227，34.4%；p<；0.001)相比，HSCT患者的全因死亡率(239/415，57.5%)更高。HSCT患者预后不良的独立因素是中性粒细胞减少、肾功能不全、肝功能不全、早发性IA、已证实的IA和甲基强的松龙的使用。相比之下，白人种族与死亡风险降低有关。在SOT患者中，肝功能不全、营养不良和中枢神经系统疾病是较差的预后指标；而强的松的使用与死亡风险的降低有关。在接受抗真菌治疗的HSCT或SOT患者中，使用两性霉素B制剂作为初始治疗的一部分与死亡风险增加相关。有多个变量与移植后IA患者的存活率有关。了解这些预后因素可能有助于治疗算法和临床试验的发展。
Invasive aspergillosis (IA) is an important cause of morbidity and mortality in hematopoietic stem cell (HSCT) and solid organ transplant (SOT) recipients. The purpose of this study was to evaluate factors associated with mortality in transplant patients with IA. Transplant patients from 23 U.S. centers were enrolled from March 2001 to October 2005 as part of the Transplant Associated Infection Surveillance Network (TRANSNET). 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. 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 (239/415, 57.5%) when compared to SOT patients (78/227, 34.4%; p<0.001). 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 CNS 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. 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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影响因子：
11.8
作者：
Walsh, Thomas J.;Raad, Issam;Perfect, John R.
通讯作者：
Perfect, John R.
影响因子：
11.8
作者：
Ascioglu, S;Rex, JH;Walsh, TJ
通讯作者：
Walsh, TJ
影响因子：
11.8
作者：
Ribaud, P;Chastang, C;Gluckman, E
通讯作者：
Gluckman, E
影响因子：
11.8
作者：
Upton, Arlo;Kirby, Katharine A.;Marr, Kieren A.
通讯作者：
Marr, Kieren A.
DOI：
10.1086/590566
发表时间：
2008-09-01
期刊：
Clinical infectious diseases : an official publication of the Infectious Diseases Society of America
影响因子：
--
作者：
Segal BH;Herbrecht R;Stevens DA;Ostrosky-Zeichner L;Sobel J;Viscoli C;Walsh TJ;Maertens J;Patterson TF;Perfect JR;Dupont B;Wingard JR;Calandra T;Kauffman CA;Graybill JR;Baden LR;Pappas PG;Bennett JE;Kontoyiannis DP;Cordonnier C;Viviani MA;Bille J;Almyroudis NG;Wheat LJ;Graninger W;Bow EJ;Holland SM;Kullberg BJ;Dismukes WE;De Pauw BE
通讯作者：
De Pauw BE