Baseline platelet count and creatinine clearance predict the outcome of neutropenia-related invasive aspergillosis.
Clin Infect Dis. 2012 Mar 15;
Authors: Nouér SA, Nucci M, Kumar NS, Grazziutti M, Restrepo A, Anaissie E
BackgroundInvasive aspergillosis (IA) is a life-threatening infection among immunocompromised patients. Improving IA outcome has been hampered by lack of early prognostic factors, i.e. available before starting chemotherapy (baseline) or early in the course of IA (non-baseline). We hypothesized that prognostic factors can be identified before chemotherapy, within seven days from first positive serum Aspergillus galactomannan index (s-GMI).MethodsWe analyzed 98 patients with multiple myeloma who developed neutropenia-related IA and had positive s-GMI. Three response criteria were used: kinetics of s-GMI, EORTC/MSG definitions and six-week survival. Baseline and non-baseline variables were analyzed separately.ResultsIndependent response predictors at baseline were platelets ?65,000/mm(3) (OR 1.009; 95% CI 1.001 - 1.017, p=0.03) by s-GMI kinetics, and platelets ?65,000/mm(3) (OR 1.009, 95% CI 1.002 - 1.017, p=0.01) and creatinine clearance (CrCl) ?53 ml/min (OR 1.024, 95% CI 1.006 - 1.042, p=0.009) by EORTC/MSG criteria, with 83% and 28% response rates when both variables were above or below these cutoffs, respectively (p<0.001). Only baseline CrCl ?53 ml/min predicted six-week survival (p=0.003). Normalization of s-GMI within 7 days from first positive test and neutrophil recovery were the non-baseline factors associated with positive outcomes.ConclusionsTwo simple, inexpensive, widely available and routinely collected pre-chemotherapy tests, platelet counts and CrCl, predict IA outcome and stratify patients into low, intermediate and high risk categories while early evaluation of s-GMI allows timely treatment modification. These findings may improve patient outcomes by optimizing management strategies for this serious infection and may prove valuable in designing clinical trials of IA.
PMID: 22423136 [PubMed - as supplied by publisher]