Table 4.
Predictors of mortality within 42 days of initiation of IA therapy in patients with hematologic malignancy and aspergillosis
| Variables | Univariate | Multivariate analysis | |||
|---|---|---|---|---|---|
| Dead (n = 132) N (%) |
Alive (n = 208) N (%) |
p-value | HR (95% CI) | p-value | |
| Age (years), median (range) | 50 (16–80) | 56 (14–86) | 0.07 | – | |
| Gender, male | 84 (64) | 119 (57) | 0.24 | – | |
| Diagnosis of invasive aspergillosis | 0.001 | 0.023 | |||
| Definite | 54 (41) | 50/207 (24) | 1.5 (1.1, 2.2) | ||
| Probable | 78 (59) | 157/207 (76) | Referent | ||
| Type of IA infection a | 0.16 | 0.007 | |||
| Invasive pulmonary infection | 111 (84) | 174 (84) | 3.3 (1.5, 7.2) | (0.003) | |
| Disseminated infection | 13 (10) | 12 (6) | 4.0 (1.6, 10.3) | (0.003) | |
| Localized or sinus infection | 8 (6) | 22 (11) | Referent | ||
| Type of cancer | 0.05 | – | |||
| Leukemia | 106/131 (81) | 148/205 (72) | |||
| Lymphoma | 23/131 (18) | 43/205 (21) | |||
| Myeloma | 2/131 (2) | 14/205 (7) | |||
| Transplantation within 1 year prior to infection | 41/131 (31) | 91 (44) | 0.022 | 0.60 (0.41, 0.88) | 0.008 |
| Type of transplantation within prior year | 0.06 | ||||
| Allogeneic transplant | 39/41 (95) | 74/91 (81) | |||
| Autologous transplant | 2/41 (8) | 17/91 (19) | |||
| Graft vs Host Disease (GVHD) | 29/39 (74) | 53/74 (72) | 0.76 | ||
| Neutropenia (< 500 ANC) at onset of IA | 79/130 (61) | 76/199 (38) | < .0001 | – | |
| Persistent neutropenia | 59/130 (45) | 63/179 (35) | 0.07 | – | |
| Received immunotherapy | 92 (70) | 108/205 (53) | 0.002 | – | |
| Received WBC transfusion | 31 (23) | 24/206 (12) | 0.004 | – | |
| Year of IA diagnosis/treatment | < .0001 | – | |||
| 1993–2004 | 99 (75) | 87 (42) | |||
| 2005–2016 | 33 (25) | 121 (58) | |||
| Prophylactic antifungal treatment prior to infection | 36 (27) | 76/207 (37) | 0.07 | 0.61 (0.41, 0.90) | 0.012 |
| Breakthrough | 29/36 (81) | 69/75 (92) | 0.11 | ||
| Primary therapy strategy | < .0001 | < .0001 | |||
| Diagnostic-driven therapy with voriconazole | 2 (2) | 42 (20) | Referent | ||
| Empiric antifungal therapy without voriconazole | 123 (93) | 97 (47) | 18.0 (4.4, 73.2) | (< .0001) | |
| Empiric antifungal therapy with voriconazole | 7 (5) | 69 (33) | 2.2 (0.5, 10.6) | (0.33) | |
IA = Invasive aspergillosis; WBC = White blood cell; HR = Hazard ratio; 95% CI = 95% Confidence interval
aAll patients with more than one types of IA infections in this study had invasive pulmonary infection and were included in invasive pulmonary infection category in this analysis