Early detection of Aspergillus spp. from lower respiratory tract is associated with higher mortality in viral CAP: A multicenter prospective cohort study in China

Abstract

Abstract Purpose:Community-acquire pneumonia (CAP) is one of the leading causes of death among adults worldwide and one of the world's most burdened diseases. Previous studies have suggested that viral pneumonia, especially severe influenza virus pneumonia, tends to be superinfected with Aspergillus. But the clinical features and prognostics in viral CAP patients with detection of Aspergillus in the early onset of the disease were unclear. Methods: We conducted a multicenter prospective observational cohort study in China of CAP patients. Adult patients with CAP in 6 hospitals from January 2017 to October 2018 were enrolled. Lower respiratory tract specimens (including sputum and alveolar lavage fluid) were collected within 72 hours after admission. Molecular biology techniques were used to conduct comprehensive pathogenic testing on collected specimens, including bacteria, atypical pathogens, viruses and fungi. A unified electronic medical record website system was used to collect patient clinical data. Results:A total of 382 adult CAP patients were enrolled. The positive rate of virus was 38% (145/382), and Aspergillus was 11.0% (16/145) in viral CAP. The mortality of Aspergillus-positive patients (25%, 4/16) was significantly higher than that of Aspergillus-negative patients (5.4%, 7/129) in viral CAP (P=0.021). In multivariable Logistic regression models, positive Aspergillus at admission significantly increased the mortality of viral CAP [OR (95%CI) =5.81 (1.48, 22.73), P=0.011]. The lymphocyte count in Aspergillus-positive patients was significantly lower than that of Aspergillus-negative patients (P=0.047). Conclusion:The positive detection results of Aspergillus from lower respiratory tract were associated with higher mortality in viral CAP. Trial registration: ClinicalTrials.gov, NCT03093220. Registered retrospectively on 28 March 2017.