Skip to main content
Journal cover image

Utility of CT assessment in hematology patients with invasive aspergillosis: a post-hoc analysis of phase 3 data.

Publication ,  Journal Article
Jin, J; Wu, D; Liu, Y; Pan, S; Yan, JL; Aram, JA; Lou, Y-J; Meng, H; Chen, X; Zhang, X; Schwartz, IS; Patterson, TF
Published in: BMC Infect Dis
May 28, 2019

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).

Duke Scholars

Altmetric Attention Stats
Dimensions Citation Stats

Published In

BMC Infect Dis

DOI

EISSN

1471-2334

Publication Date

May 28, 2019

Volume

19

Issue

1

Start / End Page

471

Location

England

Related Subject Headings

  • Voriconazole
  • Tomography, X-Ray Computed
  • Prospective Studies
  • Platelet Count
  • Middle Aged
  • Microbiology
  • Mannans
  • Male
  • Lung
  • Karnofsky Performance Status
 

Citation

APA
Chicago
ICMJE
MLA
NLM
Jin, J., Wu, D., Liu, Y., Pan, S., Yan, J. L., Aram, J. A., … Patterson, T. F. (2019). Utility of CT assessment in hematology patients with invasive aspergillosis: a post-hoc analysis of phase 3 data. BMC Infect Dis, 19(1), 471. https://doi.org/10.1186/s12879-019-4039-7
Jin, Jie, Depei Wu, Yang Liu, Sisi Pan, Jean Li Yan, Jalal A. Aram, Yin-Jun Lou, et al. “Utility of CT assessment in hematology patients with invasive aspergillosis: a post-hoc analysis of phase 3 data.BMC Infect Dis 19, no. 1 (May 28, 2019): 471. https://doi.org/10.1186/s12879-019-4039-7.
Jin J, Wu D, Liu Y, Pan S, Yan JL, Aram JA, et al. Utility of CT assessment in hematology patients with invasive aspergillosis: a post-hoc analysis of phase 3 data. BMC Infect Dis. 2019 May 28;19(1):471.
Jin, Jie, et al. “Utility of CT assessment in hematology patients with invasive aspergillosis: a post-hoc analysis of phase 3 data.BMC Infect Dis, vol. 19, no. 1, May 2019, p. 471. Pubmed, doi:10.1186/s12879-019-4039-7.
Jin J, Wu D, Liu Y, Pan S, Yan JL, Aram JA, Lou Y-J, Meng H, Chen X, Zhang X, Schwartz IS, Patterson TF. Utility of CT assessment in hematology patients with invasive aspergillosis: a post-hoc analysis of phase 3 data. BMC Infect Dis. 2019 May 28;19(1):471.
Journal cover image

Published In

BMC Infect Dis

DOI

EISSN

1471-2334

Publication Date

May 28, 2019

Volume

19

Issue

1

Start / End Page

471

Location

England

Related Subject Headings

  • Voriconazole
  • Tomography, X-Ray Computed
  • Prospective Studies
  • Platelet Count
  • Middle Aged
  • Microbiology
  • Mannans
  • Male
  • Lung
  • Karnofsky Performance Status