Serial assessment of pulmonary lesion volume by computed tomography allows survival prediction in invasive pulmonary aspergillosis

• Verfasst von: Vehreschild, Jörg Janne [VerfasserIn]
• Verfasst von: Heußel, Claus Peter [VerfasserIn]
• Titel: Serial assessment of pulmonary lesion volume by computed tomography allows survival prediction in invasive pulmonary aspergillosis
• Verf.angabe: J.J. Vehreschild, C.P. Heussel, A.H. Groll, M.J.G.T. Vehreschild, G. Silling, G. Würthwein, M. Brecht, O.A. Cornely
• E-Jahr: 2017
• Jahr: 12 January 2017
• Umfang: 8 S.
• Fussnoten: Gesehen am 25.09.2018
• Titel Quelle: Enthalten in: European radiology
• Ort Quelle: Berlin : Springer, 1991
• Jahr Quelle: 2017
• Band/Heft Quelle: 27(2017), 8, Seite 3275-3282
• ISSN Quelle: 1432-1084
• ISSN Quelle: 1613-3757
• DOI: doi:10.1007/s00330-016-4717-4
• Datenträger: Online-Ressource
• Sprache: eng
• Sach-SW: Biomarkers
• Sach-SW: Caspofungin
• Sach-SW: Computed tomography
• Sach-SW: Invasive pulmonary aspergillosis
• Sach-SW: Survival
• K10plus-PPN: 158126903X

Abstract

BackgroundSerial chest CT is the standard of care to establish treatment success in invasive pulmonary aspergillosis (IPA). Data are lacking how response should be defined.MethodsDigital CT images from a clinical trial on treatment of IPA were re-evaluated and compared with available biomarkers. Total volume of pneumonia was added up after manual measurement of each lesion, followed by statistical analysis.ResultsOne-hundred and ninety CT scans and 309 follow-up datasets from 40 patients were available for analysis. Thirty-one were neutropenic. Baseline galactomannan (OR 4.06, 95%CI: 1.08-15.31) and lesion volume (OR 3.14, 95%CI: 0.73-13.52) were predictive of death. Lesion volume at d7 and trend between d7 and d14 were strong predictors of death (OR 20.01, 95%CI: 1.42-282.00 and OR 15.97, 95%CI: 1.62-157.32) and treatment being rated as unsuccessful (OR 4.75, 95%CI: 0.94-24.05 and OR 40.69, 95%CI: 2.55-649.03), which was confirmed by a Cox proportional hazards model using time-dependent covariates.ConclusionAny increase in CT lesion volume between day 7 and day 14 was a sensitive marker of a lethal outcome (>50%), supporting a CT rescan each one and 2 weeks after initial detection of IPA. The predictive value exceeded all other biomarkers. Further CT follow-up after response at day 14 was of low additional value. Key Points • CT evaluation offers good prediction of outcome for invasive pulmonary aspergillosis.• Predictive capability exceeds galactomannan, blood counts, and lesion count.• Any progression between day 7 and day 14 constitutes a high-risk scenario.