目的 研究重度肝硬化合并侵袭性肺曲霉菌病(IPA)患者的临床特征和短期预后的危险因素。 方法 本研究为回顾性队列研究。采用随机抽样的方法连续性收集2011年12月1日至2022年12月1日，因肝硬化就诊于首都医科大学附属北京佑安医院的患者。随访患者诊断为IPA后28 d的结局，记录为死亡或存活。比较死亡组和存活组患者的临床特征、治疗和预后，采用Kaplan-Meier生存曲线评估使用伏立康唑和非使用伏立康唑治疗的患者预后，采用Cox回归分析患者的预后危险因素。 结果 本研究共纳入74例重度肝硬化合并IPA的患者，随访28 d，死亡36例，病死率为48。6%(36/74)。死亡组患者的年龄(57。4±11。7)岁大于存活组(49。4±14。7)岁，差异有统计学意义(t＝2。58，P<0。05)。2组患者的性别、吸烟、重度肝硬化的病因、临床表现、合并症、影像学表现，差异均无统计学意义(均P>0。05)。死亡组患者的白细胞计数、降钙素原、血肌酐和国际标准化比值，呼吸衰竭的比例，住院期间接受侵入性操作≥5次的比例，以及因病情加重入住重症监护室的比例，均高于存活组患者(均P<0。05)。Kaplan-Meier生存分析提示，与使用非伏立康唑治疗IPA的重度肝硬化患者相比，使用伏立康唑者28 d病死率更低[40。0%(20/50)比66。7%(16/24)，χ2＝4。54，P＝0。033]。Cox多因素回归分析显示PCT≥0。5 μg/L(RR：3。743，95%CI：1。435～9。763，P<0。05)和呼吸衰竭(RR：2。586，95%CI：1。291～5。177，P<0。05)是重度肝硬化合并IPA患者短期预后的独立危险因素。 结论 重度肝硬化合并IPA患者的短期病死率高。PCT≥0。5 μg/L和呼吸衰竭是这类患者短期预后的独立危险因素。使用伏立康唑治疗重度肝硬化患者的IPA，病死率相对较低。 Objective To investigate the clinical features of the patients with severe liver cirrhosis complicated by invasive pulmonary aspergillosis (IPA) and to explore the risk factors for short-term prognosis。 Methods This study was a retrospective cohort study。The data of the patients diagnosed with liver cirrhosis and treated at Beijing You An Hospital affiliated to Capital Medical University from December 1， 2011， to December 1， 2022 were collected using a random sampling method。The outcome of the patients 28 days after diagnosis of IPA was followed up and recorded as death or survival。Clinical characteristics， treatment， and prognosis were compared between the death and survival groups， the prognosis of patients treated with and without voriconazole was assessed using Kaplan-Meier survival curves， and the prognostic risk factors were identified using Cox regression。 Results A total of 74 patients with severe liver cirrhosis complicated by IPA were included in this study。The patients were followed up for 28 days， with 36 deaths， resulting in a mortality rate of 48。6% (36/74)。 The age of the death patients was significantly higher than that of the survivors (57。4±11。7) years vs (49。4±14。7) years， with statistical significance (t=2。58， P<0。05)。 There were no statistically significant differences between the two groups in terms of gender， smoking， etiology of severe liver cirrhosis， clinical manifestations， comorbidities， and radiological findings (P>0。05)。 Compared with the survivors， the patients in the death group had higher white blood cell counts， procalcitonin (PCT) levels， serum creatinine， international normalized ratio (INR)， proportion of respiratory failure， proportion of invasive procedures performed ≥5 times during hospitalization， and proportion of intensive care unit (ICU) admission due to disease exacerbation， (P<0。05)。 Kaplan-Meier survival analysis indicated that compared with severe liver cirrhosis patients treated with non-voriconazole therapy for IPA， those treated with voriconazole had a lower 28-day mortality rate (40。0%[20/50]vs 66。7%[16/24]， P=0。037)。 Cox multivariate regression analysis showed that PCT≥0。5 μg/L ( RR: 3。743， 95%CI: 1。435-9。763， P<0。05)and respiratory failure (RR: 2。586， 95%CI: 1。291-5。177， P<0。05)were independent risk factors for short-term prognosis of these patients。 Conclusions Short-term mortality rate is high in patients with severe liver cirrhosis complicated by IPA。PCT≥0。5 μg/L and respiratory failure are independent risk factors for short-term prognosis in such patients。Using voriconazole to treat IPA patients with severe liver cirrhosis is associated with relatively lower mortality rate。
Clinical features and short-term prognosis of severe liver cirrhosis patients with invasive pulmonary aspergillosis
Objective To investigate the clinical features of the patients with severe liver cirrhosis complicated by invasive pulmonary aspergillosis (IPA) and to explore the risk factors for short-term prognosis. Methods This study was a retrospective cohort study.The data of the patients diagnosed with liver cirrhosis and treated at Beijing You An Hospital affiliated to Capital Medical University from December 1, 2011, to December 1, 2022 were collected using a random sampling method.The outcome of the patients 28 days after diagnosis of IPA was followed up and recorded as death or survival.Clinical characteristics, treatment, and prognosis were compared between the death and survival groups, the prognosis of patients treated with and without voriconazole was assessed using Kaplan-Meier survival curves, and the prognostic risk factors were identified using Cox regression. Results A total of 74 patients with severe liver cirrhosis complicated by IPA were included in this study.The patients were followed up for 28 days, with 36 deaths, resulting in a mortality rate of 48.6% (36/74). The age of the death patients was significantly higher than that of the survivors (57.4±11.7) years vs (49.4±14.7) years, with statistical significance (t=2.58, P<0.05). There were no statistically significant differences between the two groups in terms of gender, smoking, etiology of severe liver cirrhosis, clinical manifestations, comorbidities, and radiological findings (P>0.05). Compared with the survivors, the patients in the death group had higher white blood cell counts, procalcitonin (PCT) levels, serum creatinine, international normalized ratio (INR), proportion of respiratory failure, proportion of invasive procedures performed ≥5 times during hospitalization, and proportion of intensive care unit (ICU) admission due to disease exacerbation, (P<0.05). Kaplan-Meier survival analysis indicated that compared with severe liver cirrhosis patients treated with non-voriconazole therapy for IPA, those treated with voriconazole had a lower 28-day mortality rate (40.0%[20/50]vs 66.7%[16/24], P=0.037). Cox multivariate regression analysis showed that PCT≥0.5 μg/L ( RR: 3.743, 95%CI: 1.435-9.763, P<0.05)and respiratory failure (RR: 2.586, 95%CI: 1.291-5.177, P<0.05)were independent risk factors for short-term prognosis of these patients. Conclusions Short-term mortality rate is high in patients with severe liver cirrhosis complicated by IPA.PCT≥0.5 μg/L and respiratory failure are independent risk factors for short-term prognosis in such patients.Using voriconazole to treat IPA patients with severe liver cirrhosis is associated with relatively lower mortality rate.
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