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

Objective: To analyze the risk factors,clinical features and prognosis of chronic obstructive pulmonary disease(COPD)complicated with invasive pulmonary aspergillosis(IPA).Methods: From January 2014 to December 2019,we selected55 patients who both have COPD and IPA that come to Department of Respiratory and critical Medicine,the first affiliated Hospital of Chongqing Medical University as the study group(IPA-COPD group),and we also randomly selected 55 patients with COPD but without IPA in the same period as the control group(n IPA-COPD group).The risk factors of COPD patients complicated with IPA were analyzed by logistic regression,and we compared the two groups’ clinical characteristics.According to the follow-up results,we divided the IPA-COPD group into survival group and death group.Cox survival analysis was used to determine the prognostic factors of COPD patients with IPA.Results:1.There were significant differences in clinical manifestations such as hemoptysis,fever and fatigue between the two groups(P < 0.05).2.IPA-COPD group is more likely to appear cavity,halo sign,air crescent sign,mass shadow,wedge consolidation,large consolidation shadow,tree bud sign,pleural effusion and other imaging findings.3.There were significant differences in serum β-D-glucan test,serum galactomannan(GM)test,white blood cell count,lymphocyte count,C-reactive protein and oxygenation index between the two groups.4.The level of albumin in IPA-COPD group was lower than that in control group.5.Risk factors for COPD complicated with IPA include using glucocorticoid for more than 2 weeks,systemic use of glucocorticoid,invasive operation,ventilator-assisted ventilation and hypoalbuminemia.6.The mortality rate of patients in IPA-COPD group was 38.2%.Multivariate analysis showed that mechanical ventilation and the increase of serum lactate dehydrogenase were able to improve the risk of death in patients with IPA-COPD.Conclusion: 1.Long-term use of glucocorticoids,especially systemic use of corticosteroids in COPD patients,especially those with invasive operation,ventilator-assisted ventilation and hypoalbuminemia,should be vigilant against the occurrence of IPA.2.Serum G test,serum GM test,GM test and metagenomic next generation sequencing of bronchoalveolar lavage fluid are helpful for early diagnosis of IPA.3.The prognosis of COPD complicated with IPA is poor.Mechanical ventilation and elevated LDH are independent risk factors for death of COPD patients with IPA.In order to reduce the mortality,we should earlierly diagnose and treat the patients with COPD who have high risk factors to happen IPA.