Aspergillosis, ABPA-Related Hospitalizations in Cystic Fibrosis Confer Worse Outcomes

This article is part of Pulmonology Advisor‘s coverage of the CHEST 2019 meeting, taking place in New Orleans, LA. Our staff will report on medical research related to asthma, COPD, critical care medicine, and more conducted by experts in the field. Check back regularly for more news from CHEST 2019.

NEW ORLEANS — Patients with aspergillosis-pulmonary cystic fibrosis (CF) have worse outcomes, according to research presented at the CHEST Annual Meeting 2019 held October 19 to 23, 2019, in New Orleans, Louisiana. Significantly longer hospitalizations compared with patients with CF were also noted in those with aspergillosis-CF and allergic bronchopulmonary aspergillosis (ABPA)-CF.

To determine the epidemiology and outcomes of aspergillosis and ABPA in patients with CF and its outcomes, investigators conducted a descriptive retrospective study using data from the Nationwide Inpatient Sample databases between 2005 and 2014.

The incidence of CF-related hospitalizations remained constant from 2005 to 2014, with 635 per million admissions and 624 per million admissions, respectively, and an annual percentage change of 2.14.

On the basis of the admissions data, patients with CF (mean age, 21.9±12.05 years) were predominantly white (86.3%) and women (54.2%); 3.65% were black. In total, 30.86% of patients with CF had concomitant aspergillosis, and concomitant ABPA was noted in 3.4% of patients with CF.

The trend of aspergillosis- and ABPA-related hospitalizations in patients with CF has significantly increased from 2005 to 2014 (annual percentage change, 3.5 [P <.001] and annual percentage change, 8.4 [P <.001], respectively). The adjusted risk for aspergillosis-CF was significantly higher in patients with chronic kidney disease (odds ratio [OR], 1.56; CI, 1.08-2.26; P =.02) and patients experiencing weight loss (OR, 1.19; CI, 1.02-1.4; P =.03).

Patients with aspergillosis-CF had significantly higher rates of acute respiratory failure (OR, 1.63; CI, 1.32-2.02; P <.001), mechanical ventilation (OR, 2.38; CI, 1.79-3.16; P <.001), and inpatient mortality (OR, 1.77; CI, 1.19-2.61; P =.004) than those patients with CF but without aspergillosis or ABPA. Significantly longer hospitalizations (4 days; CI, 3.14-4.87; P <.001) were also seen in patients with aspergillosis-CF compared with patients with CF but without aspergillosis or ABPA.

The adjusted risk for ABPA-CF was significantly higher in patients with asthma (OR, 1.62; CI, 1.31-2; P <.001) and in patients experiencing weight loss (OR, 1.38; CI, 1.17-1.63; P <.001), but significantly lower in women (OR, 0.78; CI, 0.67-0.92, P =.002). Patients with ABPA-CF had significantly longer hospitalization (1.65 days; CI, 1.01-2.29; P <.001); however, the rates of acute respiratory failure, mechanical ventilation, and inpatient mortality were not significantly different compared with those of patients without aspergillosis or ABPA.

As the number of hospitalizations for aspergillosis and ABPA has been growing in the United States, physicians should be aware that almost one-third of patients with CF also have aspergillosis, which is associated with worse outcomes.

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Reference

Singh S, Acharya P, Naaraayan A, Durdevic M, Nimkar A, Jesmajian S. Aspergillosis and allergic bronchopulmonary aspergillosis (ABPA) in pulmonary cystic fibrosis-related hospitalizations in the United States. Presented at: CHEST Annual Meeting 2019; October 19-23, 2019; New Orleans, LA. Abstract 414.