Prognostic Factors for Mortality in Chronic Pulmonary Aspergillosis - Experience in Japan-

Background: Chronic pulmonary aspergillosis (CPA) is a chronic progressive infection which develops in patients with underlying lung diseases. It typically causes prolonged and relapsing cough, dyspnea, and hemoptysis. It is also associated with significant morbidity and mortality, but the prognostic factors have yet to be determined. The aim of the present study was to clarify them in CPA. Methods: We retrospectively reviewed the medical records of 141 inpatient and outpatient cases, who were clinically diagnosed with CPA from April 2013 to March 2019 at National Hospital Organization Ibarakihigashi National Hospital, a regional hospital in Japan. Results: Of those cases, 117(83%) were male, 102(72%) were smokers and their median age at diagnosis was 73 years, and median body mass index was 18.5 kg/m2. As for the pre-existing pulmonary diseases, patients with interstitial pneumonia were 45 cases(32%), with COPD were 32 cases(23%) and with pulmonary tuberculosis and. nontuberculous mycobacterial lung diseases were 61 cases(43%). During the observation period, 59(42%) patients died. Evaluating the differences in clinical findings between the death group and the survival group by using multivariable Cox proportional hazard model, we identified lower BMI(<18), lower albumin(<3g/dl) and the history of acute exacerbation by the endobronchial spread of the disease as the prognostic factors for mortality. Of 23 cases presenting acute exacerbation, 20 patients(87%) died. Conclusions: We conclude that lower BMI, lower albumin and the history of acute exacerbation might be the prognostic factors for mortality. The last mentioned complication might be especially a newer prognostic factor.