In-hospital mortality among hematological malignancy patients undergoing bronchoscopy for suspected invasive pulmonary aspergillosis: Focusing on coinfections and nodules on chest CT

Abstract

IntroductionInvasive pulmonary aspergillosis (IPA) in hematological malignancy populations has high mortality rates. While there are identified prognostic factors for mortality, conflicting results are reported from the studies including bronchoalveolar lavage galactomannan (GM) measurements and co-infections. We aimed to evaluate risk factors associated with in-hospital mortality in a hematological malignancy population undergoing bronchoscopy with a preliminary diagnosis of IPA in a single tertiary care center.MethodPatients undergoing bronchoscopy with a preliminary diagnosis of IPA were included in this retrospective study. Bacterial co-infection was defined as a positive bacterial culture in respiratory samples within +/- 7 days of the index bronchoscopy procedure.ResultsStudy population consisted 305 patients diagnosed as possible, probable or proven IPA. 57 patients presented with fungal and bacterial co-infection. In-hospital mortality was observed in 98 (33.6%) patients. Patients with mortality status were older and were not in remission for hematological malignancy. Serum GM, bronchoalveolar lavage (BAL) GM and bronchial lavage (BL) GM levels showed a significant relation with in-hospital mortality but weak accuracy. In multivariate analysis for risk factors of in-hospital mortality; age, remission status, number of nodules in HRCT and having fungal infections with or without combined bacterial infection were independent risk factors.ConclusionCo-infections in this susceptible population should not be overlooked even in the presence of fungal infection evidence. BAL and BL GM tended to have a stronger relation with survival than serum GM measurements taken at the same time. The number of nodules in radiological assessment might be an indicator of mortality. Radiological changes through the disease course might be assessed in further studies.