Utility of CT assessment in hematology patients with invasive aspergillosis: a post-hoc analysis of phase 3 data
Abstract Background Pulmonary computed tomography (CT) scans are commonly used as part of the clinical criteria in diagnostic workup of invasive fungal diseases like invasive aspergillosis, and may identify radiographic abnormalities, such as halo signs or air-crescent signs. We assessed the diagnos...
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BMC
2019-05-01
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| Series: | BMC Infectious Diseases |
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| Online Access: | http://link.springer.com/article/10.1186/s12879-019-4039-7 |
| _version_ | 1828394561607565312 |
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| author | Jie Jin Depei Wu Yang Liu Sisi Pan Jean Li Yan Jalal A. Aram Yin-jun Lou Haitao Meng Xiaochen Chen Xian’an Zhang Ilan S. Schwartz Thomas F. Patterson |
| author_facet | Jie Jin Depei Wu Yang Liu Sisi Pan Jean Li Yan Jalal A. Aram Yin-jun Lou Haitao Meng Xiaochen Chen Xian’an Zhang Ilan S. Schwartz Thomas F. Patterson |
| author_sort | Jie Jin |
| collection | DOAJ |
| description | Abstract Background Pulmonary computed tomography (CT) scans are commonly used as part of the clinical criteria in diagnostic workup of invasive fungal diseases like invasive aspergillosis, and may identify radiographic abnormalities, such as halo signs or air-crescent signs. We assessed the diagnostic utility of CT assessment in patients with hematologic malignancies or those who had undergone allogeneic hematopoietic stem cell transplantation in whom invasive aspergillosis was suspected. Methods This post-hoc analysis assessed data from a prospective, multicenter, international trial of voriconazole (with and without anidulafungin) in patients with suspected invasive aspergillosis (IA; proven, probable, or possible, using 2008 European Organisation for Research and Treatment of Cancer/Invasive Fungal Infections Cooperative Group and the National Institute of Allergy and Infectious Diseases Mycoses Study Group criteria) [NCT00531479]. Eligible patients received at least one baseline lung CT scan. Results Of 395 patients included in this post-hoc analysis, 240 patients (60.8%) had ‘confirmed’ proven (9/240, 3.8%) or probable (231/240, 96.3%) invasive aspergillosis (cIA) and 155 patients (39.2%) had ‘non-confirmed’ invasive aspergillosis (all nIA; all possible IA (de Pauw et al., Clin Infect Dis 46:1813–21, 2008)). Mean age was 52.3 and 50.5 years, 56.3 and 60.0% of patients were male, and most patients were white (71.7 and 71.0%) in the cIA and nIA populations, respectively. Median baseline galactomannan was 1.4 (cIA) and 0.2 (nIA), mean Karnofsky score was 65.3 (cIA) and 66.8 (nIA), and mean baseline platelet count was 48.0 (cIA) and 314.1 (nIA). Pulmonary nodules (46.8% of all patients), bilateral lung lesions (37.5%), unilateral lung lesions (28.4%), and consolidation (24.8%) were the most common radiographic abnormalities. Ground-glass attenuation (cIA: 24.2%; nIA: 11.6%; P < 0.01) and pulmonary nodules (cIA: 52.5%; nIA: 38.1%; P < 0.01) were associated with cIA. Other chest CT scan abnormalities (including halo signs and air-crescent signs) at baseline in patients with hematologic malignancy or hematopoietic stem cell transplantation, and suspected IA, were not associated with cIA. Conclusions These findings highlight the limitations in the sensitivity of chest CT scans for the diagnosis of IA, and reinforce the importance of incorporating other available clinical data to guide management decisions on individual patients, including whether empirical treatment is reasonable, pending full evaluation. Trial registration NCT00531479 (First posted on ClinicalTrials.gov on September 18, 2007) |
| first_indexed | 2024-12-10T07:56:29Z |
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| language | English |
| last_indexed | 2024-12-10T07:56:29Z |
| publishDate | 2019-05-01 |
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| spelling | doaj.art-bead5b81c75546579f6664863844555e2022-12-22T01:56:53ZengBMCBMC Infectious Diseases1471-23342019-05-011911910.1186/s12879-019-4039-7Utility of CT assessment in hematology patients with invasive aspergillosis: a post-hoc analysis of phase 3 dataJie Jin0Depei Wu1Yang Liu2Sisi Pan3Jean Li Yan4Jalal A. Aram5Yin-jun Lou6Haitao Meng7Xiaochen Chen8Xian’an Zhang9Ilan S. Schwartz10Thomas F. Patterson11Department of Hematology, First Affiliated Hospital, Zhejiang University College of MedicineDepartment of Hematology, First Affiliated Hospital, Soochow UniversityPfizer IncPfizer IncPfizer IncPfizer IncDepartment of Hematology, First Affiliated Hospital, Zhejiang University College of MedicineDepartment of Hematology, First Affiliated Hospital, Zhejiang University College of MedicineDepartment of Hematology, First Affiliated Hospital, Zhejiang University College of MedicinePfizer IncDivision of Infectious Diseases, Department of Medicine, University of AlbertaDivision of Infectious Diseases, UT Health Science San AntonioAbstract Background Pulmonary computed tomography (CT) scans are commonly used as part of the clinical criteria in diagnostic workup of invasive fungal diseases like invasive aspergillosis, and may identify radiographic abnormalities, such as halo signs or air-crescent signs. We assessed the diagnostic utility of CT assessment in patients with hematologic malignancies or those who had undergone allogeneic hematopoietic stem cell transplantation in whom invasive aspergillosis was suspected. Methods This post-hoc analysis assessed data from a prospective, multicenter, international trial of voriconazole (with and without anidulafungin) in patients with suspected invasive aspergillosis (IA; proven, probable, or possible, using 2008 European Organisation for Research and Treatment of Cancer/Invasive Fungal Infections Cooperative Group and the National Institute of Allergy and Infectious Diseases Mycoses Study Group criteria) [NCT00531479]. Eligible patients received at least one baseline lung CT scan. Results Of 395 patients included in this post-hoc analysis, 240 patients (60.8%) had ‘confirmed’ proven (9/240, 3.8%) or probable (231/240, 96.3%) invasive aspergillosis (cIA) and 155 patients (39.2%) had ‘non-confirmed’ invasive aspergillosis (all nIA; all possible IA (de Pauw et al., Clin Infect Dis 46:1813–21, 2008)). Mean age was 52.3 and 50.5 years, 56.3 and 60.0% of patients were male, and most patients were white (71.7 and 71.0%) in the cIA and nIA populations, respectively. Median baseline galactomannan was 1.4 (cIA) and 0.2 (nIA), mean Karnofsky score was 65.3 (cIA) and 66.8 (nIA), and mean baseline platelet count was 48.0 (cIA) and 314.1 (nIA). Pulmonary nodules (46.8% of all patients), bilateral lung lesions (37.5%), unilateral lung lesions (28.4%), and consolidation (24.8%) were the most common radiographic abnormalities. Ground-glass attenuation (cIA: 24.2%; nIA: 11.6%; P < 0.01) and pulmonary nodules (cIA: 52.5%; nIA: 38.1%; P < 0.01) were associated with cIA. Other chest CT scan abnormalities (including halo signs and air-crescent signs) at baseline in patients with hematologic malignancy or hematopoietic stem cell transplantation, and suspected IA, were not associated with cIA. Conclusions These findings highlight the limitations in the sensitivity of chest CT scans for the diagnosis of IA, and reinforce the importance of incorporating other available clinical data to guide management decisions on individual patients, including whether empirical treatment is reasonable, pending full evaluation. Trial registration NCT00531479 (First posted on ClinicalTrials.gov on September 18, 2007)http://link.springer.com/article/10.1186/s12879-019-4039-7Invasive aspergillosisComputed tomography scansDiagnosisRadiographic abnormalitiesAntifungal treatmentHematopoietic stem cell transplant |
| spellingShingle | Jie Jin Depei Wu Yang Liu Sisi Pan Jean Li Yan Jalal A. Aram Yin-jun Lou Haitao Meng Xiaochen Chen Xian’an Zhang Ilan S. Schwartz Thomas F. Patterson Utility of CT assessment in hematology patients with invasive aspergillosis: a post-hoc analysis of phase 3 data BMC Infectious Diseases Invasive aspergillosis Computed tomography scans Diagnosis Radiographic abnormalities Antifungal treatment Hematopoietic stem cell transplant |
| title | Utility of CT assessment in hematology patients with invasive aspergillosis: a post-hoc analysis of phase 3 data |
| title_full | Utility of CT assessment in hematology patients with invasive aspergillosis: a post-hoc analysis of phase 3 data |
| title_fullStr | Utility of CT assessment in hematology patients with invasive aspergillosis: a post-hoc analysis of phase 3 data |
| title_full_unstemmed | Utility of CT assessment in hematology patients with invasive aspergillosis: a post-hoc analysis of phase 3 data |
| title_short | Utility of CT assessment in hematology patients with invasive aspergillosis: a post-hoc analysis of phase 3 data |
| title_sort | utility of ct assessment in hematology patients with invasive aspergillosis a post hoc analysis of phase 3 data |
| topic | Invasive aspergillosis Computed tomography scans Diagnosis Radiographic abnormalities Antifungal treatment Hematopoietic stem cell transplant |
| url | http://link.springer.com/article/10.1186/s12879-019-4039-7 |
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