Τίτλος:
Elderly versus nonelderly patients with invasive aspergillosis in the ICU: A comparison and risk factor analysis for mortality from the AspICU cohort
Γλώσσες Τεκμηρίου:
Αγγλικά
Περίληψη:
Data regarding the epidemiology and diagnosis of invasive aspergillosis in the critically ill population are limited, with data regarding elderly patients (=75 years old) even scarcer. We aimed to further compare the epidemiology, characteristics and outcome of elderly versus nonelderly critically ill patients with invasive aspergillosis (IA) Prospective, international, multicenter observational study (AspICU) including adult intensive care unit (ICU) patients, with a culture and/or direct examination and/or histopathological sample positive for Aspergillus spp. at any site.We compared clinical characteristics and outcome of IA in ICU patients using two different diagnostic algorithms. Elderly and nonelderly ICU patients with IA differed in a number of characteristics, including comorbidities, clinical features of the disease, mycology testing, and radiological findings. No difference regarding mortality was found. According to the clinical algorithm, elderly patients were more likely to be diagnosed with putative IA. Elderly patients had less diagnostic radiological findings and when these findings were present they were detected late in the disease course. The comparison between elderly survivors and nonsurvivors demonstrated differences in clinical characteristics of the disease, affected sites and supportive therapy needed. All patients who were diagnosed with proven IA died. Increased vigilance combined with active search for mycological laboratory evidence and radiological confirmation are necessary for the timely diagnosis of IA in the elderly patient subset. Although elderly state per se is not a particular risk factor formortality, a high SOFA score and the decision not to administer antifungal therapy may have an impact on survival of elderly patients. © The Author(s) 2017.
Συγγραφείς:
Matthaiou, D.K.
Dimopoulos, G.
Taccone, F.S.
Bulpa, P.
Van Den Abeele, A.M.
Misset, B.
Meersseman, W.
Spapen, H.
Cardoso, T.
Charles, P.E.
Vogelaers, D.
Blot, S.
Περιοδικό:
Medical Mycology
Εκδότης:
Oxford University Press
Λέξεις-κλειδιά:
galactomannan; immunosuppressive agent; selenium; antifungal agent, adult; aged; antifungal therapy; Article; clinical decision making; clinical feature; clinical laboratory; cohort analysis; comorbidity; comparative study; controlled study; critically ill patient; disease course; epidemiological data; evidence based practice; female; fungus culture; histopathology; hospital mortality; human; human tissue; intensive care unit; invasive aspergillosis; major clinical study; male; mortality rate; mortality risk; multicenter study; mycology; observational study; outcome assessment; prospective study; risk assessment; risk factor; Sequential Organ Failure Assessment Score; very elderly; aspergillosis; cause of death; clinical trial; critical illness; diagnostic imaging; Europe; factor analysis; middle aged; mortality; standards; statistics and numerical data; systemic mycosis; treatment outcome, Aged; Antifungal Agents; Aspergillosis; Cause of Death; Cohort Studies; Critical Illness; Europe; Factor Analysis, Statistical; Female; Humans; Intensive Care Units; Invasive Fungal Infections; Male; Middle Aged; Prospective Studies; Risk Factors; Treatment Outcome
