AB0517 Invasive aspergillosis in patients with systemic lupus erythematosus: a retrospective study focus on clinical characteristics and risk factors of in-hospital mortality
Authors: H. Mingli, C.-Y. Tsai
Journal: Annals of the Rheumatic Diseases (2018)

<h3>Objectives</h3> To analyse the clinical features and outcomes of patients with invasive aspergillosis (IA), the mortality risk factors and all-cause mortality in patients with systemiclupus erythematosus (SLE) in single centre of Taiwan. <h3>Methods</h3> A retrospective study was performed to identify the mortality risk factors associated with IA in patients with systemic lupuserythematosus (SLE). We reviewed the medical records of patients with SLE who were diagnosed with invasive aspergillosis between Jan. 2006 and Jun. 2017 fromTaipei Veterans General Hospital in Taiwan. Clinical and laboratory parameters as well as treatment outcomes were analysed. <h3>Results</h3> Twenty-one patientsdiagnosed with proven (n=4; 19.04%) and probable (n=17; 80.95%)invasive aspergillosis according to revised definition by European Organisation for Research and Treatment of Cancer/Invasive Fungal Infections Cooperative Group and the National Institute of Allergy and Infectious Diseases Mycoses Study Group (EORTC/MSG) Consensus Groupwere enrolled in the study and separated into survivors(n=7; 33.33%) and non-survivors (n=14; 66.67%) groups. All patients in invasive aspergillosis demonstrated significantly high incidence of pneumonia(n=19;90.47%), concurrent infections (n=17; 80.95%), and high mortality (n=14; 66.67%). The coinfections with bacteremia(n=8;38.10%), cytomegalovirus (n=9; 42.86%), and candida (n=6; 28.57%) were common in patients with invasive aspergillosis. Gram-negative bacilli (38 isolates; 69.09%), of which the most common isolates were carbapenem-resistant Acinetobacter baumannii (8 isolates; 21.05%). The most common Gram-positive isolates were methicillin-resistant Staphylococcus aureus (6 isolates; 35.29%), followed by Vancomycin-resistant Enterococcus (4 isolates; 23.52%). The daily glucocorticoid dose≧20 mg(p=0.007, HR 2.000, 95% CI 1.185–3.377), rates of recent pulse glucocorticoid therapy (p=0.022, HR 2.800, 95% CI 1.387–5.654), rates of azathioprine use (p=0.022, HR 2.000, 95% CI 1.185–3.377), rates of rituximab within six months (p=0.022, HR 2.000, 95% CI 1.185–3.377), plasmapheresis during hospital course (p=0.022, HR 2.000, 95% CI 1.185–3.377), and acute respiratory distress syndrome (p=0.022, HR 2.000, 95% CI 1.185–3.377) among non-survivor group were statistically higher than the survivor group. Non-survivors had significantly higher rate ofconcurrent infections (p=0.002, HR 5.667, 95% CI 2.029–15.824) and cytomegalovirus (CMV) viremia (p=0.040, HR 1.750, 95% CI 1.112–2.775) than survivors. The sensitivity of Galactomannan assay was not good to excludethe diagnosis of invasive aspergillosis. Septic shock (n=7, 50% of non-survivor group) is the most common cause of in-hospital mortality in patients with invasive aspergillosis. <h3>Conclusions</h3> The daily glucocorticoid dose≧20 mg, recent pulse glucocorticoid therapy, azathioprine, rituximab within six months, concurrent infections, and CMV viremia are risk factors of in-hospital mortality in invasive aspergillosis patients with Systemic Lupus Erythematosus. within six months, concurrent infections, and CMV viremia are risk factors of in-hospital mortality in invasive aspergillosis patients with Systemic Lupus Erythematosus. within six months, concurrent infections, and CMV viremia are risk factors of in-hospital mortality in invasive aspergillosis patients with Systemic Lupus Erythematosus. <h3>Reference</h3> [1] Patterson TF, Thompson GR, Denning DW, et al. Practice Guidelines for the Diagnosis and Management of Aspergillosis: 2016 Update by the Infectious Diseases Society of America. Clinical Infectious Diseases: An Official Publication of the Infectious Diseases Society of America2016;63(4):e1–e60. doi:10.1093/cid/ciw326 <h3>Disclosure of Interest</h3> None declared