Risk Factors And Prognosis Of Chronic Obstructive Pulmonary Disease With Invasive Pulmonary Aspergillosis

BackgroundInvasive pulmonary aspergillosis(IPA)is a pneumonia characterized by invasion of pulmonary parenchyma,erosion of blood vessels,and necrosis caused by a conditional fungus of the aspergillus genus.It is commonly seen in malignant tumors of the blood system,allogeneic hematopoietic stem cell transplantation,and acquired immune deficiency diseases.However,in recent years,the incidence of IPA has also been increasing in patients with chronic obstructive pulmonary disease(COPD)and other non-traditional high-risk groups.Impaired ciliary activity,immunosuppression by inhibition of alveolar macrophages and neutrophils,and systemic steroid and broad-spectrum antimicrobial use in COPD patients create opportunities for aspergillus invasion.In addition,due to the persistence of risk factors such as smoking and air pollution and the acceleration of population aging,the prevalence,disability rate and death rate of COPD are increasing year by year.The survival rate and survival days of patients with COPD combined with IPA were significantly lower than those without IPA,and the fatality rate was as high as 70%?80%.However,the non-specificity of the clinical manifestations(such as fever,cough and purulent sputum)and the infrequency of typical imaging features such as"halo sign " and "air-crescent sign" in traditional high-risk patients pose challenges to the early diagnosis in IPA of COPD patients.ObjectiveThis study aims to summarize the clinical characteristics,high risk factors and prognostic factors of COPD combined with IPA through retrospective case-control study,so as to further improve the level of clinical diagnosis and treatment,and provide help for early diagnosis and treatment and improvement of patients'prognosis.MethodsRetrospective analysis was performed on 1140 patients with COPD who were hospitalized in the respiratory department of our hospital from January 2016 to December 2018.97 patients with COPD combined with IPA were selected as the observation group according to the admission criteria,and 97 patients with non-IPA were selected as the control group according to the principle of 1:1,and the medical records and follow-up data of the first hospitalization were analyzed.The data of patients in the two groups were analyzed by statistical method,P<0.05 means the difference was statistically significant.The risk factors of COPD combined with IPA were analyzed by Logistic univariate and multivariate analysis,and the survival analysis by COX regression model was carried out to select the prognostic risk factors of COPD combined with IPA.Result(1)The duration of COPD,the number of acute exacerbations of COPD,GOLD stage ?,and cardiovascular diseases in the observation group were all higher than those in the control group,with statistically significant differences(P<0.05).(2)The non-specific clinical manifestations in the observation group were:increased sputum volume,expectoration with drawing,hemoptysis and dyspnea;Pulmonary nodules,pulmonary cavities,and localized bronchiectasis were more common in pulmonary imaging,while typical crescent and halo signs were less common.(3)The mMRC and CAT scores of the observation group were higher than those of the control group,and the determination results of 6MWT were lower than those of the control group(P<0.05).(4)Multivariate analysis showed that the risk factors for COPD associated with IPA included the number of acute exacerbations of COPD,long-term oxygen therapy,ICU admission history,and antibiotic application ?10 days(P<0.05).(5)The mortality rate of patients with COPD combined with IPA was 29.897%,and the risk factors affecting the prognosis included complicated cardiovascular disease,ICU admission history,COPD course,and pulmonary function grade ?(P<0.05).Conclusion(1)Patients with COPD combined with IPA had poor daily life quality and exercise endurance.However its clinical manifestation and imaging lack of specificity.However,the important basis for IPA diagnosis is GM experiment and lower respiratory tract specimen culture,especially the acquisition of samples under tracheal microscope,which is sometimes limited by the patient's condition and the rate of examination is low.In addition,tissue biopsies required for IPA diagnosis are also limited by patients' conditions and other characteristics,which limit their clinical application.(2)The number of acute exacerbations of COPD,long-term oxygen therapy,ICU admission history,antibiotic application?>10 days,combined cardiovascular disease and diabetes,hypoproteinemia,COPD course,anemia,systemic hormone application and GOLD stage ? were risk factors for COPD with IPA;(3)Combined cardiovascular disease,ICU admission history,COPD course and GOLD stage ? are prognostic factors affecting COPD combined with IPA.