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Higher risk for influenza-associated pulmonary aspergillosis (IAPA) in asthmatic patients. A Swiss multicenter cohort study on IAPA in critically ill influenza patients.
  • +14
  • Frederike Waldeck,
  • Filippo Boroli,
  • Sandra Zingg,
  • Laura Walti,
  • Pedro Wendel Garcia,
  • Anna Conen,
  • Jean-Luc Pagani,
  • Katia Boggian,
  • Madeleine Schnorf,
  • Martin Siegemund,
  • Samia Abed-Maillard,
  • Marc Michot,
  • Yok-Ai Que,
  • Veronika Baettig,
  • Noemie Suh,
  • Gian-Reto Kleger,
  • Werner Albrich
Frederike Waldeck
Universitätsklinikum Schleswig-Holstein Campus Lübeck

Corresponding Author:[email protected]

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Filippo Boroli
HUG
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Sandra Zingg
Universitätsspital Basel
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Laura Walti
Inselspital Universitatsspital Bern
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Pedro Wendel Garcia
UniversitätsSpital Zürich
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Anna Conen
Kantonsspital Aarau AG
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Jean-Luc Pagani
CHUV
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Katia Boggian
Kantonsspital St Gallen
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Madeleine Schnorf
CHUV
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Martin Siegemund
Universitätsspital Basel
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Samia Abed-Maillard
CHUV
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Marc Michot
Kantonsspital Thun
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Yok-Ai Que
Inselspital Universitatsspital Bern
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Veronika Baettig
Universitätsspital Basel
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Noemie Suh
HUG
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Gian-Reto Kleger
Kantonsspital St Gallen
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Werner Albrich
Kantonsspital St Gallen
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Abstract

Background: Influenza-associated pulmonary aspergillosis (IAPA) is an important complication of severe influenza with high morbidity and mortality. Methods: We conducted a retrospective multicenter study in tertiary hospitals in Switzerland during 2017/18 and 2019/20 influenza seasons. All adults with PCR-confirmed influenza infection and treatment on intensive-care unit (ICU) for >24h were included. IAPA was diagnosed according to previously published clinical, radiological and microbiological criteria. We assessed risk factors for IAPA and predictors for poor outcome which was a composite of in-hospital mortality, ICU length of stay ≥7d, mechanical ventilation ≥7d or extracorporeal membrane oxygenation. Results: 158 patients (median age 64 years, 45% females) with influenza were included, of which 17 (10.8%) had IAPA. Asthma was more common in IAPA patients (17% vs. 4% in non-IAPA, p=0.05). Asthma (OR 12.0 (95% CI 2.1-67.2)) and days of mechanical ventilation (OR 1.1 (1.1 – 1.2)) were associated with IAPA. IAPA patients frequently required organ supportive therapies including mechanical ventilation (88% in IAPA vs. 53% in non-IAPA, p=0.001) and vasoactive support (75% vs. 45%, p=0.03) and had more complications including ARDS (53% vs. 26%, p=0.04), respiratory bacterial infections (65% vs. 37%, p=0.04) and higher ICU-mortality (35% vs. 16.4%, p=0.05). IAPA (OR 28.8 (3.3–253.4)), influenza A (OR 3.3 (1.4-7.8)) and higher SAPS II score (OR 1.07 (1.05—1.10)) were independent predictors of poor outcome. Interpretation: High clinical suspicion, early diagnostics and therapy are indicated in IAPA because of high morbidity and mortality. Asthma is likely an underappreciated risk factor for IAPA.
01 Sep 2022Submitted to Influenza and other respiratory viruses
02 Sep 2022Submission Checks Completed
02 Sep 2022Assigned to Editor
15 Sep 2022Editorial Decision: Accept