Identification of Prognostic Factors of Chronic Pulmonary Aspergillosis: a Retrospective Cohort of 106 Patients

Background: The morbidity and mortality of chronic pulmonary aspergillosis (CPA) are very high. We aimed to investigate the prognostic factors of patients with CPA, especially focusing on the underlying pulmonary disease and the probable co-infection of bacterial.

Methods: We retrospectively analyzed 106 CPA patients from November 2019 to August 2023. We collected the patient's clinical medical records. Kaplan-Meier survival curves were used to analyze patient survival; log-rank tests were utilized to compare survival among groups. Univariate and multivariate Cox proportional hazards regression analyses were applied for identification of potential prognostic factors.

Results: The mean age at the time of diagnosis was 60.3±14.8 years; 74 (69.8%) patients were male. There was significant difference between patients with and without lung cancer (P<0.001), and with and without emphysema (P=0.02). Other prognosis factors associated with mortality were as follows: smoking (P=0.04), cough (P=0.01), simultaneous discovery with Gram-negative bacteria (P=0.02), and hypoalbuminemia (P=0.001) in log-rank tests. Multivariate Cox regression analyses showed that emphysema [hazard ratio (HR), 4.107; 95% confidence interval (CI): 1.414-11.933; P=0.009] and lung cancer (HR, 8.511; 95% CI: 2.494-29.047; P<0.001) were identified as independent predictors of mortality. The 1- and 3-year survival rates with emphysema were 75.2% and 64.9%, respectively, whereas those for patients without emphysema were 92.6% and 85.9%, respectively.

Conclusions: In the current study, emphysema and lung cancer were independent predictors of mortality. Therefore, we should pay attention to the patients with these underlying lung diseases in order to improve the prognosis.